Exempt a SIM from the Patient Responsibility Percent

File Maintenance Help for NextGen® Enterprise 8

Set Up Patient Responsibility Schedules

The Patient Responsibility Schedule defines the percentage used in conjunction with a payer that requires the patient to be responsible for a certain percentage of the allowed amount. At charge entry, after all automatic adjustments, SIM exceptions, and contract exceptions are applied but before any sliding fee adjustments are applied, the Patient Responsibility percentage is used to distribute the remaining charge balance between the Ins1 bucket and the patient responsibility bucket. The distribution is based on the percentage determined by the patient's HOH family size and income. For example, if the patient's family size and income qualify for a 40% patient responsibility, a $100 charge balance splits to $60 in the Ins1 bucket and $40 in the patient responsibility bucket. The split also occurs when the ER SIM is inserted. You can create multiple patient responsibility schedules and then apply them to payers. To set up the patient responsibility percentages, do the following: Under t

File Maintenance Help for NextGen® Enterprise 8

Apply Patient Responsibility Schedule to Payers

After you save a Patient Responsibility Schedule, you can configure the schedule for one or more specific payers. Only one active schedule can exist for a payer. If there is already an existing schedule for a payer, it must be expired before you can configure another schedule for that payer. To apply a patient responsibility schedule to payers, do the following: In the Patient Responsibility master file, select the applicable patient responsibility schedule row. Select the Open Menu button, and then select Payer Configurations. The Configure Payer window opens. If the schedule row applies to all payers, select the All Payers check box, and then select OK. To apply the row to specific payers, select the Open Menu button, and then select New. The Payers window opens. Use the arrows to move the items from the Available list to the Included list, and then select OK. Any selected payer names display on the Configure Payer window. Note: To remove a payer from the list, select the payer name

Help Guide for NextGen® Enterprise PM 8

Exempt a SIM from the Patient Responsibility Percent

Not all SIMs are covered under the patient responsibility percentage. If an individual SIM needs to be exempt from the patient responsibility percentage, you can disable the percentage for the SIM. When a SIM is exempt, the entire charge balance for that SIM remains in the Ins1 bucket and is not split. To exempt a SIM from the Patient Responsibility Percent, do the following: Open the Service Items library, and then select the SIM that should be exempt. Select the Payer tab, and then select the Disable Patient Responsibility Percent check box. To save changes and close the window, select OK. Parent topic: Patient Responsibility

Help Guide for NextGen® Enterprise PM 8

Set Up Patient Responsibility Schedules

The Patient Responsibility Schedule defines the percentage used in conjunction with a payer that requires the patient to be responsible for a certain percentage of the allowed amount. At charge entry, after all automatic adjustments, SIM exceptions, and contract exceptions are applied but before any sliding fee adjustments are applied, the Patient Responsibility percentage is used to distribute the remaining charge balance between the Ins1 bucket and the patient responsibility bucket. The distribution is based on the percentage determined by the patient's HOH family size and income. For example, if the patient's family size and income qualify for a 40% patient responsibility, a $100 charge balance splits to $60 in the Ins1 bucket and $40 in the patient responsibility bucket. The split also occurs when the ER SIM is inserted. You can create multiple patient responsibility schedules and then apply them to payers. To set up the patient responsibility percentages, do the following: Under t

File Maintenance Help for NextGen® Enterprise 8

Exempt SIM-Related Charges

You can exempt SIM-related charges from encounter bills and statements. Exempt charges display in the Charge Posting window line item listing, but are not added to the total charge for the encounter. Open a Service Item library and then select a SIM. Set the following fields: Encounter billing exempt : Select this check box to not add the charge associated with the SIM to the patient's encounter bill or statement. If a SIM is set up to be Encounter billing exempt, then it will essentially be written off 100% (auto-adjustment) to the corresponding Encounter Exempt Patient Adjustment Code. While this charge will still appear in the Charge Entry window and the Encounter registers, it will NOT appear on anything going to a patient (such as statement, encounter bill, or invoice). Exempt patient adjustment code: When you select the Encounter billing exempt check box, you must select an Exempt pat adj code to indicate the reason that the SIM charge is exempt. Parent topic: General Tab

File Maintenance Help for NextGen® Enterprise 8

Set Default SIM Exceptions for Self-Pay Patients at Practice Level

You can set a default SIM exception at the practice and location levels to use for self-pay encounters when patients have no insurance. Open Practice Preferences, then select the Libraries Preferences. In Private Pay SIM Exception, select the SIM exception to set as the default when patients are designated as self-pay. Select OK. Parent topic: Setting Up an Exception through the SIM Library

Exempt a SIM from the Patient Responsibility Percent

Recommendations

Set Up Patient Responsibility Schedules

Apply Patient Responsibility Schedule to Payers

Exempt a SIM from the Patient Responsibility Percent

Set Up Patient Responsibility Schedules

Exempt SIM-Related Charges

Set Default SIM Exceptions for Self-Pay Patients at Practice Level

Set Up Patient Responsibility Schedules

Apply Patient Responsibility Schedule to Payers

Exempt a SIM from the Patient Responsibility Percent

Set Up Patient Responsibility Schedules

Exempt SIM-Related Charges

Set Default SIM Exceptions for Self-Pay Patients at Practice Level