Modifier Reimbursement Setup
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File Maintenance Help for NextGen® Enterprise 8
Modifier Reimbursement Tab
You can determine surgical reimbursement based on a percentage of the charge amount. The Modifier Reimbursement tab enables you to create a series of modifiers and modifier combinations that are associated with a percentage reduction of allowed amount. If the system cannot find the exact CPT4 code and modifier combination on the Fee Schedule tab, it uses the percentage on the Modifier Reimbursement tab. For example, the scenario under which this tab would be referenced is as follows: You enter a charge and specify a two-digit modifier. The system attempts to find the row in the Contracts library Fee Schedule tab, but the CPT4 code and modifier combination that was entered does not exist in the contract. The system attempts to find the row in the Fee Schedule tab by using only the CPT4 code without the modifier and succeeds. The system attempts to find the row in the Contract Modifier Reimbursement tab using only the modifier that was specified on the charge entry screen and succeeds. T
Help Guide for NextGen® Enterprise PM 8
Set Up Modifier Reimbursement
In File Maintenance, open Libraries > Contract Parent topic: Modifier Reimbursement in Cost Estimation
Help Guide for NextGen® Enterprise PM 8
Workflow for Alternate Payer
Parent topic: Alternate Payers
File Maintenance Help for NextGen® Enterprise 8
Workflow for Alternate Payer
Parent topic: Alternate Payers
Help Guide for NextGen® Enterprise PM 8
Modifier Reimbursement in Cost Estimation
Surgical reimbursement is calculated based on a percentage of the charge amount. The contract allowed amount for procedures can be automatically reduced based on charge modifiers The contract allowed amounts for surgeries involving multiple procedures can be automatically reduced based on the charge order/sequence The contract allowed amount for endoscopy procedures can be calculated as the difference between the allowed defined for the "Billed CPT®4" and the allowed defined for the "Base CPT®4" When the allowed amount has been determined, it is then used in the standard calculation of the adjustment amount: [SIM Library Price]-[Contract Allowed Amount]=[Adjustment Amount] You can configure the modifier reimbursement in File Maintenance Libraries > Contract. The Modifier Reimbursement tab enables you to create a series of modifiers and modifier combinations that are associated with a percentage reduction of an allowed amount. If the system cannot find the exact CPT®4 code and modifier
Help Guide for NextGen® Enterprise PM 8
Set Up Multiple Procedure Discount
In File Maintenance, open Libraries > Contract Parent topic: Multiple Procedure Discounting in Cost Estimation
