Set Up Patient Responsibility Schedules

File Maintenance Help for NextGen® Enterprise 8

Set Up Poverty Percentages and Categories

You enter federal poverty guidelines by creating poverty percentages and by assigning poverty categories to the percentages. Once poverty percentages are set up, you can add them to: Patient Data Sheets and Fee Tickets in Practice Preferences > Data\Fee Ticket. Forms and labels in the Form Templates and Label Templates master files. To define poverty percentages, do the following: Access File Maintenance. Select System Master Files > Patient Responsibility. The Patient Responsibility Maintenance window opens. This window contains a table with columns and rows. If this is the first time you've opened the Patient Responsibility master file, the first column displays 100 in the first row for poverty percentage. The poverty percentages are entered in the first row across the top of the table. Poverty categories are listed in the second row. The family size, which is the total number of family members, is listed in the first column down the left side of the table. The family annual income i

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

File Maintenance Help for NextGen® Enterprise 8

Enable Percent of Poverty

Percent of Poverty is enabled in Practice Preferences. Once enabled, if a valid family size and annual income exist for the Head of Household (HOH), then the Percent of Poverty and Poverty Category from the Patient Responsibility master file display in NextGen® Enterprise PM for all patients linked to the HOH. If the family size and income are changed for the HOH, then the percent and category update accordingly for all patients linked to the HOH. To enable Percent of Poverty for a practice, do the following: Access File Maintenance. Select System Master Files > Practices. The Practice List window opens. Select and open the desired Practice. The Modify Practice Information window opens. Select the Preferences button. The Practice Preferences window opens. In the Preference List on the left, select Sliding Fee. Select the Display Percent of Poverty check box. To save changes and close the window, select OK. In NextGen® Enterprise PM, Percent of Poverty and Poverty Category display in th

File Maintenance Help for NextGen® Enterprise 8

Enable Patient Poverty Alerts

Two types of alerts can display in NextGen® Enterprise PM for patients whose family size and income fit within an active poverty percentage and patient responsibility schedule: Patient Responsibility alert Percent of Poverty alert The Patient Responsibility alert informs you that, based on the patient's head-of-household information, the patient is placed on a patient responsibility schedule. The alert includes the patient responsibility schedule name, percentage of patient responsibility, family size, income, poverty percentage, and poverty category. The Percent of Poverty alert informs you either of the following: If the patient has head-of-household information, the alert includes the poverty percentage, poverty category, family size, and income. This alert displays only when no payers have been configured for the patient responsibility schedule. Note: If payers have been configured, then the Patient Responsibility alert displays instead. If the patient lacks head-of-household infor

File Maintenance Help for NextGen® Enterprise 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

Set Up Patient Responsibility Schedules

Recommendations

Set Up Poverty Percentages and Categories

Apply Patient Responsibility Schedule to Payers

Enable Percent of Poverty

Enable Patient Poverty Alerts

Exempt a SIM from the Patient Responsibility Percent

Set Up Patient Responsibility Schedules

Set Up Poverty Percentages and Categories

Apply Patient Responsibility Schedule to Payers

Enable Percent of Poverty

Enable Patient Poverty Alerts

Exempt a SIM from the Patient Responsibility Percent

Set Up Patient Responsibility Schedules