Applying Exceptions to Charges

File Maintenance Help for NextGen® Enterprise 8

Setting Up an Exception through the SIM Library

In the SIM library, you can create a new SIM exception or modify existing ones. Note: You must set up all SIM Exceptions, Groups, and SIM Exception Groups before you attach them to a provider. For information on attaching the appropriate SIM to a provider, see the section Assigning Exceptions for the Provider, Payer, and Location in the File Maintenance Master Files Guide for NextGen® Enterprise. Set Up a New SIM Exception Modify Existing SIM Exceptions Setting Up More Than One Exception per SIM Set Default SIM Exceptions for Self-Pay Patients at Practice Level Set Default SIM Exceptions for Self-Pay Patients at Location Level Parent topic: SIM Exceptions

File Maintenance Help for NextGen® Enterprise 8

SIM Exceptions

You can charge different fees according to provider, location, and payer. Additional fees are referred to as exceptions, which can be set up and maintained through the SIM Item Library or Contract Library. Setting Up an Exception through the SIM Library Applying Exceptions to Charges Parent topic: Service Items Library

Help Guide for NextGen® Enterprise PM 8

Charge Posting Overview

On the Charge Posting window in NextGen® Enterprise PM, you can enter new charges or modify existing charges on patient encounters or company invoices. A charge is any service or procedure that is rendered to a patient by a provider within the practice. All charges include the following fields. Service Date Service Item (SIM) Code CPT4 Code Quantity Unit Price Diagnosis Codes Rendering Provider Place of Service Location Access the Charge Posting Window You can open the Charge Posting window to enter or modify Charges. Charge Posting Toolbar Charge Posting toolbar enables you to access icons to perform different actions, while working with charges. Navigating the Charge Posting Window You can use hot-key commands to navigate the charge posting window. Charge Posting Additional Fields You can enable additional fields for specific types of billing. Parent topic: Billing and Collections

Help Guide for NextGen® Enterprise PM 8

Retrieving Charge Amount in Cost Estimation

Charge amount is the amount a healthcare provider sets for the rendering services before applying any discounts. The pricing for a service depends on whether the place of service is a facility or non-facility location. If you are the administrator, you can set the Non-Facility Price and Facility Price fields for a specific SIM code in the SIM library and SIM exception. For information on setting up the pricing for a service item in File Maintenance, go to the NextGen Healthcare Success Community and download the File Maintenance Libraries Guide forNextGen®Enterprise. When you estimate the patient cost, the value for the charge amount is returned as follows: If the charge amount is set in the SIM exception and SIM library, the value in the SIM exception returns. If the charge amount is set in the SIM exception only, the value in the SIM exception returns. If the charge amount is set in the SIM library only, the value in the SIM library returns. If the charge amount is not set in the SIM

File Maintenance Help for NextGen® Enterprise 8

Assigning Exceptions for the Provider, Payer, and Location

A provider can have exceptions to how charges are normally paid. To be able to apply these exceptions to a charge, you must assign them to the provider for each service location/payer combination. For each combination, you can assign one contract exception and one SIM exception. You can attach a SIM and a contract exception to the provider at a specific location for all payers or for specific payers. A SIM or contract exception for a specific payer overrides the default exception. To assign exceptions to the provider, payer, and location: From the Master Files - System list, select Providers. Double-click on a provider from the list or highlight the provider and select the Open Menu button. The Modify Provider Information dialog box displays. Select the Practice tab. Under Service Location, select the applicable location. A list of payers displays in the Group Information section. If you want to set the default for all payers, double-click the Default row in the Group Information secti

Help Guide for NextGen® Enterprise PM 8

Contract Exceptions

You can charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider/payer/location level in order to apply the exceptions to charges. Setting Up Exceptions In the Contract Library Parent topic: Contracts Library

Applying Exceptions to Charges

Recommendations

Setting Up an Exception through the SIM Library

SIM Exceptions

Charge Posting Overview

Retrieving Charge Amount in Cost Estimation

Assigning Exceptions for the Provider, Payer, and Location

Contract Exceptions

Applying Exceptions to Charges

Setting Up an Exception through the SIM Library

SIM Exceptions

Charge Posting Overview

Retrieving Charge Amount in Cost Estimation

Assigning Exceptions for the Provider, Payer, and Location

Contract Exceptions