Encounter-Based Sliding Fee Schedule

File Maintenance Help for NextGen® Enterprise 8

Encounter-Based Versus Line Item-Based Sliding Fee Schedules

In some situations, a line item-based sliding fee schedule can produce dramatically different charges for a patient than an encounter-based sliding fee schedule. For example: If you apply a line item-based sliding fee schedule with a minimum payment of $50 and a 90% discount to a patient encounter with charges of $150, $40, and $10, the schedule applies the minimum payment to each charge resulting in a total charge of $150 to the patient. (When a discount results in a charge that is less than the minimum payment, as in this example, the application overrides the discount and applies the minimum fee. No charge can be less than the schedule’s minimum payment.) If you apply an encounter-based sliding fee schedule with the same discount and minimum payment to the encounter, the schedule takes the total of the charges ($200) applies the discount and minimum payment, and arrives at a total charge to the patient of $50. Note: When a patient has insurance, the application does not automaticall

File Maintenance Help for NextGen® Enterprise 8

Line Item Based Sliding Fee Schedule

When the application applies a sliding fee schedule discount by line item, it applies the discount to each charge immediately after the charge is entered on an encounter. Therefore, a line item-based sliding fee schedule can be applied multiple times for an encounter. Parent topic: Sliding Fee Schedules

File Maintenance Help for NextGen® Enterprise 8

Sliding Fee Schedules

The Sliding Fee Schedule master file enables you to: Create active sliding fee schedules. Activate NextGen® Enterprise PM alerts that: Indicate when patients have an associated sliding fee schedule. Notify users when certain information pertaining to the sliding fee schedule must be re-verified. Exempt certain service items from the sliding fee schedule. In NextGen® Enterprise PM, you can: Attach sliding fee schedules to a patient's chart. Apply a sliding fee schedule discount against patient responsibility charges and automatically calculate discounts based on the active Sliding Fee Schedule. Apply more than one sliding fee schedule to an encounter. Report on the sliding fee schedule adjustment discounts. The modes of applying a sliding fee schedule to a patient’s charges are: Line item-based. Encounter-based. The Sliding Fee Schedule Practice Preferences provide additional options that you can set on a per practice basis. Line Item Based Sliding Fee Schedule Encounter-Based Sliding F

Help Guide for NextGen® Enterprise PM 8

Applying Sliding Fee Schedules to Charges

When a Sliding Fee Schedule is attached to a patient or guarantor account profile, the Sliding Fee Schedule can be applied against charges for an encounter and the application automatically calculates the adjustment. You can right-click on a line item in the Encounter Maintenance window and either remove or apply a sliding fee adjustment. If the insurance for a patient is discovered to be expired after charges have been applied to the encounter, the patient becomes eligible for a sliding fee adjustment. You can apply the sliding fee adjustment on the line item in the Encounter Maintenance window. Note: Sliding Fee adjustments uses the same process date as the charge process date. If it is overridden, the transaction posting date for the adjustment reflects the current date. Sliding Fee Schedule attached at the encounter level overrides Sliding Fee Schedule attached at the patient level. You can also attach more than one Sliding Fee Schedule to an encounter. This process can occur in th

Help Guide for NextGen® Enterprise PM 8

Apply Sliding Fee Adjustments to a Single Encounter

Calculating and applying a Sliding Fee Schedule to an encounter On Demand can only be done when the Insurance Amounts 1, 2 and 3 in Balance Control are equal to zero and the Patient Amount in Balance Control is greater than zero. For example, if payers are attached to an encounter, then the encounter must be billed and all payments from the payers must be posted, leaving only a patient balance. Note: The Sliding Fee Schedule must be encounter based. Open NextGen® Enterprise PM. Select the Chart button on the main toolbar. The Patient Lookup window opens. Enter Search Criteria to locate the desired patient. Select Find. From the search results, double-click to open the desired patient. The Patient Chart opens. Select the Encounters tab. Right-click on the desired encounter, and then select Sliding Fee. To view the sliding fee adjustment, select the Transactions tab. Note: If you add the sliding fee or process while the chart is open, you must close the chart and re-open it to see the cr

Help Guide for NextGen® Enterprise PM 8

Encounter-Based and Line Item-Based Sliding Fees

In some cost estimation situations, a line-item based sliding fee adjustment can produce dramatically different estimated amounts for a patient or person than an encounter-based sliding fee adjustment as shown in the following examples. For example: If you apply a line-item based sliding fee adjustment with a minimum payment of $50 and a 90% discount to a patient or person encounter with estimated amounts of $150, $40, and $10, the adjustment applies the minimum payment to each estimated amount resulting in a total estimated amount of $150 to the patient or person. Note: When an adjustment results in an estimated amount that is less than the minimum payment, as in this example, the system overrides the adjustment and applies the minimum fees. The estimated amount cannot be less than the adjustment's minimum payment. If you apply an encounter-based sliding fee adjustment with the same discount and minimum payment to the encounter, the schedule takes the total of the estimated amount ($2

Encounter-Based Sliding Fee Schedule

Recommendations

Encounter-Based Versus Line Item-Based Sliding Fee Schedules

Line Item Based Sliding Fee Schedule

Sliding Fee Schedules

Applying Sliding Fee Schedules to Charges

Apply Sliding Fee Adjustments to a Single Encounter

Encounter-Based and Line Item-Based Sliding Fees

Encounter-Based Versus Line Item-Based Sliding Fee Schedules

Line Item Based Sliding Fee Schedule

Sliding Fee Schedules

Applying Sliding Fee Schedules to Charges

Apply Sliding Fee Adjustments to a Single Encounter

Encounter-Based and Line Item-Based Sliding Fees