Allowed Amounts Subcategory

Help Guide for NextGen® Enterprise PM 8

Payment Amounts Subcategory

The three columns that are grouped into the Payment Amounts subcategory all relate to the expected and actual payment amounts of the contract or contract exception. The values that display in these columns come from either the Contract Libraries that are set up in the application or the Payment Entry window where actual payment amounts are posted against a line item charge or the value is a calculation generated by the application. The two sections that follow explain where the values that display in each of the three columns come from and how they are calculated by the application, which enables you to understand how to compare the contractual amounts to the actual amounts. The first section explains the Payment Amounts subcategory based on contracts. The second section explains the Payment Amounts subcategory based on contract exceptions. Contracts Contract Exceptions Parent topic: Contractual Analysis Report

Help Guide for NextGen® Enterprise PM 8

Adjustment Amounts Subcategories

The three columns that are grouped into the Adjustment Amounts subcategory all relate to the calculated Adjustment Amounts of the contract or contract exception. The values that display in these columns either come from the Charge Posting window where adjustments are automatically calculated by the application, based on the contract or contract exception information, and entered in the Adjustments column or the value is a calculation generated by the application. The two sections that follow explain where the values that display in each of the three columns come from and how they are calculated by the application, which enables you to understand how to compare the contractual amounts to the actual amounts. The first section explains the Adjustment Amounts subcategory based on contracts. The second section explains the Adjustment Amounts subcategory based on contract exceptions. Contracts Contract Exceptions Parent topic: Contractual Analysis Report

Help Guide for NextGen® Enterprise PM 8

Understanding the Contractual Analysis Report

The Contractual Analysis report is a good tool to regularly audit your contracts and contract exception fee schedules. The columns on the report that enables you to compare the contractual amounts, which are maintained in the Contract Libraries of the application, to the actual amounts, which are paid by the payers, as well as the adjustment amounts that are created when charges and payments are posted. The following is a list of columns, in the order that they display on the Contractual Analysis report: The Diff Allowed Amt (Difference in Allowed Amount) The Act Allowed Amt (Actual Allowed Amount) The Cont Allowed Amt (Contract Allowed Amount) The Diff Pay Amt (Difference in Payment Amount) The Diff TP Pay Amount (Difference between Contract Payment Amount and All Payment Amount) The Act TP Pay Amt (Actual Third Party Payment Amount) The Cont Pay Amt (Contract Payment Amount) The Diff Adj Amt (Difference in Adjustment Amount) The Act Adj Amount (Actual Adjustment Amount) The Cont Adj

Help Guide for NextGen® Enterprise PM 8

Contract Exceptions

When comparing the contractual amounts to the actual amounts in the Adjustment Amount subcategory, the following three columns are analyzed: The Cont Adj Amt (Contract Adjustment Amount) The values that display in the Cont Adj Amt (Contract Adjustment Amount) column are derived from a calculation generated by the application. To calculate the Cont Adj Amt, use the following equation: Cont Allowed Amt (minus [–]) Reimbursement (equals [=]) Cont Adj Amt For this example, the following Contract values are used: Cont Allowed Amt: $55.00 Reimbursed: $49.50 Cont Adj Amt: $5.50 The Act Adj Amt (Actual Adjustment Amount) The values that display in the Act Adj Amt (Actual Adjustment Amount) column come from Adjustments field on the Charge Posting window where adjustments are automatically calculated by the application, based on the contract information. Note: The Act Adj Amt (Actual Adjustment Amount) that displays on the Charge Posting window and the Contractual Analysis report is a negative d

Help Guide for NextGen® Enterprise PM 8

Contracts

When comparing the contractual amounts to the actual amounts in the Adjustment Amount subcategory, the following three columns are analyzed: The Cont Adj Amt (Contract Adjustment Amount) The values that display in the Cont Adj Amt (Contract Adjustment Amount) column are derived from a calculation generated by the application. To calculate the Cont Adj Amt, use the following equation: Cont Allowed Amt (minus [–]) Reimbursement (equals [=]) Cont Adj Amt For this example, the following Contract values are used: Cont Allowed Amt: $55.00 Reimbursed: $49.50 Cont Adj Amt: $5.50 The Act Adj Amt (Actual Adjustment Amount) The values that display in the Act Adj Amt (Actual Adjustment Amount) column come from Adjustments field on the Charge Posting window where adjustments are automatically calculated by the application, based on the contract information. Note: The Act Adj Amt (Actual Adjustment Amount) that displays on the Charge Posting window and the Contractual Analysis report is a negative d

Help Guide for NextGen® Enterprise PM 8

Retrieving Allowed Amount in Cost Estimation

Allowed amount is the amount expected to be paid by the insurance provider and patient for an individual service. The allowed amount for a service can be retrieved from the transaction history or contract library and contract exception (collectively known as contract). If you are the administrator, you can select the source for the allowed amount in the practice preferences and get the allowed amount as follows: If you select contract, the allowed amount is retrieved from the contract library or contract exception. If you select transaction history, the allowed amount is retrieved from the transaction history based on the date range you select. If found, the allowed amount is calculated based on your selection of the following options: Average of all amounts: Returns the average of the allowed amounts for a service. Latest allowed amount: Returns the allowed amount from the latest transaction. If you select both, the system looks for the allowed amount in both sources. You can also sel

Allowed Amounts Subcategory

Recommendations

Payment Amounts Subcategory

Adjustment Amounts Subcategories

Understanding the Contractual Analysis Report

Contract Exceptions

Contracts

Retrieving Allowed Amount in Cost Estimation

Payment Amounts Subcategory

Adjustment Amounts Subcategories

Understanding the Contractual Analysis Report

Contract Exceptions

Contracts

Retrieving Allowed Amount in Cost Estimation