Balance Control

Help Guide for NextGen® Enterprise PM 8

Rebill an Encounter using Balance Control

Encounters that have already been billed to insurance can be rebilled for a variety of reasons. For example, a new charge can be added to the encounter, an existing charge can be corrected and modified, or insurance has not responded to the initial claim. Balance Control is used to flag one or more charges on an encounter to be rebilled to insurance. To flag all the charges to be rebilled, do the following: Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter, and then select the Balance Control icon. The Balance Control window opens. Right-click in the R (Release to Bill) column for the payer to be rebilled. Select Select All Ins. All line items show check mark in the R (Release to Bill) column, the encounter status changes to Rebill, and the Rebill Encounter check box is automatically selected. To save changes and close the window, select OK. To flag specific charges to be rebilled, do the following: Open the Balance C

Help Guide for NextGen® Enterprise PM 8

Reassigning Charge Balances using Balance Control

Charge balances move between buckets in Balance Control based on the status selected for each line item during payment entry. You can manually reassign charge balances between buckets in Balance Control without entering a corresponding transaction. When a rejection receives from the primary payer because the patient no longer has that insurance. A $0.00 payment is posted from the payer, but a status of None is selected during payment entry which prevents charge balances from automatically moving from the Ins1 Amt bucket to the Ins2 Amt bucket. Balance Control can be used to manually reassign charge balances when needed. Reassign Insurance Balances You can reassign insurance balances on the Balance Control window. Reassign Patient Balances You can reassign patient balance on the Balance Control window. Reassign Partial Balances You can reassign partial balances from insurance to patient and patient to insurance. Parent topic: Balance Control

Help Guide for NextGen® Enterprise PM 8

Prorating Charge Balances using Balance Control

You can prorate the charge balances on an encounter between the primary and secondary insurances, or between the primary insurance and patient if no secondary insurance exists. The prorated amount is based on the fee for service allowed amount and reimbursed % defined in the fee schedule for the contract linked to the primary payer. The prorate functionality works only if the Prorate Insurance Balance check box is selected in the following areas in File Maintenance: Contracts > General tab Payers > Practice tab, Libraries sub-tab Example: A contract is set up for Medicare with fee schedule parameters as follows: CPT Code Charge Amount Allowed Amount Reimbursed % 99213 $100.00 $90.00 80% 81002 $35.00 $20.00 80% 82962 $35.00 $20.00 80% When you enter the above charges on an encounter where Medicare is the primary payer, the charges balances are automatically prorated so that 20% of the Allowed Amount moves to the Ins2 Amt bucket in Balance Control. If there is no secondary insurance on t

Help Guide for NextGen® Enterprise PM 8

Reorder Encounter Insurances using Balance Control

When the wrong insurance is attached to an encounter, or the correct insurance is attached to an encounter but in the wrong order, the incorrect insurance can be billed. You can use Balance Control to reorder encounter insurances, so the correct insurance is billed. To reorder encounter insurances using balance control, do the following: Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter, and then select the Balance Control icon. The Balance Control window opens. Select the payer to be reordered. Do one of the following: Select the blue down arrow button to move the payer to a lower order. Select the blue up arrow button to move the payer to a higher order. A confirmation message appears stating that the insurance amount follows payer to the next selected bucket. Do one of the following: Select No to leave the charge balances in the current Ins Amt bucket. Select Yes to move the charge balances out of the current Ins A

Help Guide for NextGen® Enterprise PM 8

Rebill a Batch for Secondary Insurance

Once you receive payment from the primary insurance, you can bill secondary and tertiary insurances. When an insurance is settled and responsibility has moved to the next bucket (i.e., primary insurance has paid and now it is time to bill secondary), the encounter reverts to a Rebill status. Then you must go through the billing process again. The system does not automatically rebill. Rebilling encounters is very similar to creating claims for the primary payer. From the main toolbar, select the Encounter Lookup button. In the Bill Status field, select Rebill. Follow the steps described in Billing Multiple Encounters. Note: The Include Encounters in a Billing Hold check box enables you to include or exclude encounters that are on a billing hold. For example, when searching for Rebill encounters to bill again, you may not want encounters that are being held. Therefore, you would not select this option. Parent topic: Billing Process Work Flow

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from the Charge or Payment Window

Open the Charge Posting or Payment Entry window for the desired patient encounter. From the toolbar, select the Bill Encounter button. The Encounter Bill window opens listing all charges on the encounter. If the encounter has a status of Unbilled, charges are pre-selected for billing and if the encounter has a status of Rebill, you must select the charges to be billed. To bill the selected charges, select OK. A message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The encounter is listed on the report with a message in one of the following colors. Green: An informational message indicating the encounter passed all claim edits. A pending claim is created. Blue: A warning message indicating the encounter passed all claim edits, but information is included

Balance Control

Recommendations

Rebill an Encounter using Balance Control

Reassigning Charge Balances using Balance Control

Prorating Charge Balances using Balance Control

Reorder Encounter Insurances using Balance Control

Rebill a Batch for Secondary Insurance

Bill an Individual Encounter from the Charge or Payment Window

Rebill an Encounter using Balance Control

Reassigning Charge Balances using Balance Control

Prorating Charge Balances using Balance Control

Reorder Encounter Insurances using Balance Control

Rebill a Batch for Secondary Insurance

Bill an Individual Encounter from the Charge or Payment Window