Modifier Reimbursement Setup
You can reference the Modifier Reimbursement under the following scenarios:
- When you enter a charge and specify a two-digit modifier.
- In NextGen® Enterprise PM, there is a row in the Contracts library Fee Schedule tab, but the CPT4 code and modifier combination do not exist in the contract.
- In NextGen® Enterprise PM, there is a row in the Fee Schedule tab using only the CPT4 code without the modifier and succeeds.
In NextGen® Enterprise PM, there is a row in the Contract Modifier Reimbursement tab using only the modifier that was specified on the charge entry window and succeeds.
- NextGen® Enterprise PM uses the row found in Fee Schedule, however it reduces the allowed amount by the percentage specified on the Modifier Reimbursement tab. All percentages from the reimbursement row are used to predict the payment amount, not the flat dollar amounts.