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Modifier Reimbursement Setup
Modifier Reimbursement Setup
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
Set Up Modifier Reimbursement
In File Maintenance, open Libraries > Contract Parent topic: Modifier Reimbursement in Cost Estimation
File Maintenance Help for NextGen® Enterprise
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. Parent topic: Access Contract Library Maintenance
Help Guide for NextGen® Enterprise PM 8
Workflow for Alternate Payer
Parent topic: Alternate Payers
File Maintenance Help for NextGen® Enterprise
Workflow for Alternate Payer
Parent topic: Alternate Payers
