Set Up a Fee Schedule for Contract Payers

File Maintenance Help for NextGen® Enterprise 8

Add or Modify a Contract

In File Maintenance, select Libraries > Contracts. The Contracts Libraries window opens. To add a new contract, select open menu button and select New. The Contract Library Maintenance window opens. Enter the Contract Name, Effective Date, and Expiration Date. Enter default information for the Contract. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, select the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter the information in the Automatic Adjustments section that applies. To add the CPT 4 code applicable to the contract, select the Fee Schedule tab. Then select open menu button or question mark. To find a CPT4 code, select open menu button and select Lookup to display a list of CPT4 codes and des

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 a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

File Maintenance Help for NextGen® Enterprise 8

Fields on the Fee Schedule Tab

Field Description Date Range Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000. Type Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time. Non-Facility/Facility Indicates whether the reimbursement for a service performed at a facility or non-facility service location. Allowed Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is sele

File Maintenance Help for NextGen® Enterprise 8

Access Contract Library Maintenance

Access the Contract Library Maintenance window, to create contract defaults, such as co-payments, deductibles, and physician referrals and authorizations. In File Maintenance, select Libraries and then Contract. The Contracts List window opens. Double-click the applicable library. The Contract Library Maintenance window opens. General Tab of Contract Library Maintenance Activate and Assign a Payer to a Practice You can limit a practice's access to certain Payers master files. Add or Modify a Contract Set Up a Fee Schedule for Contract Payers Modifier Reimbursement Tab Multiple Procedure Discounting Tab Payer/Provider Tab Contract Exceptions Parent topic: Contracts Library

Help Guide for NextGen® Enterprise PM 8

Add or Modify Contracts

In File Maintenance, select Libraries and then Contracts. The Contracts Libraries window opens. To add a new contract, select the open menu button, and choose New. To modify an existing contract, highlight the contract, select the open menu button, and then select Open. The Contract Library Maintenance window opens. Enter or modify the Contract Name, Effective Date, and Expiration Date. Enter or modify the Contract Defaults information. Note: The Co-Payment on Office Enc.'s check box allows you to set a default co-pay amount. The amount entered here is the default used on the Insurance Maintenance window for any patients that have insurance associated with this contract. To enter a default co-payment, enable the Co-Payment on Office Encounters check box and enter the dollar amount below it in the Default Co-Pay Amount box. Enter or modify the information in the Automatic Adjustments section that applies. Select the Fee Schedule tab. Enter or modify the CPT4 code that is applicable to t

Set Up a Fee Schedule for Contract Payers

Recommendations

Add or Modify a Contract

Modifier Reimbursement Tab

Set Up a Fee Schedule for Contract Payers

Fields on the Fee Schedule Tab

Access Contract Library Maintenance

Add or Modify Contracts

Add or Modify a Contract

Modifier Reimbursement Tab

Set Up a Fee Schedule for Contract Payers

Fields on the Fee Schedule Tab

Access Contract Library Maintenance

Add or Modify Contracts