Contract Adjustments on Charges with Calculated Amounts

Is charge Quantity >1?	Is charge Override price entered?	Is charge Extended amount recalculated?	Is Contract Adjustment applied to charge?
No	No	No	Yes
Yes	No	Yes	Yes
No	Yes	Yes	Yes (see Note 2)
Yes	Yes	Yes (see Note 1)	Yes (see Note 2)

Help Guide for NextGen® Enterprise PM 8

Automatic Adjustments - Additional Information

The following are some additional details about the automatic adjustments: An auto-adjustment transaction has a Posted status with a source of Manual Entry, and a tracking description of Auto Adjustment Batch. This batch is not accessible, and therefore the transaction cannot be modified. If you delete a charge with an associated auto-adjustment, the adjustment transaction is also deleted. The Transaction Date, Post Date and Process Date on an auto-adjustment are the same as the Create Date on the charge. If the charge is entered today and the auto-adjustment is applied today, the charge create date and the transaction dates are the same. If you enter an Override price on a charge, an auto-adjustment is applied to the charge when the Allow auto adj when charge amt overridden option is enabled in Practice Preferences > Charge Entry tab. If the Rendering provider on the charge is a non-participating provider for the contract, an auto-adjustment is not applied to the charge. If you do not

Help Guide for NextGen® Enterprise PM 8

Reverse and Correct Auto-Adjustments after a Contract Change

You can reverse outdated adjustments to selected charges and replace existing adjustments with new adjustments calculated from the updated allowed amount in the contract. Note: Reverse Automatic Adjustment process is only available to users with security rights. To reverse automatic adjustments made to charges for recently updated contracts for a batch of encounters, do the following: Open NextGen® Enterprise PM. Select File > Processes > Reverse Automatic Adjustments. The Reverse Automatic Adjustments window opens. Select the relevant contract and enter a date range in the Search Criteria section. Select Find. The application searches for applicable charges in the encounters for the following: Status of Unbilled, Billed, Rebilled and/or History Primary payer is attached to selected contract Charge service begin date in defined date range The contract allowed amount for the charge is different than the original created auto adjustment Encounter has received no third party payments The

Help Guide for NextGen® Enterprise PM 8

Contract Automatic Adjustment

When you enter a charge for SIM code with a price for a patient and primary insurance, the contract linked to the insurance specifies that the allowed amount is for the CPT4 code. You can create an automatic adjustment when the Automatically adjust charges option is enabled for the contract. Charge Amount - Allowed Amount = Adjustment Amount The automatic adjustment displays in the Adjustment column in the charge ledger section of the Charge Posting window. You can view the summary information for the adjustment transaction on the Transactions sub-tab of the Patient Chart > Encounters tab. You can view the transaction details on the Payment Entry window. Parent topic: Automatic Adjustments Overview

Help Guide for NextGen® Enterprise PM 8

Co-Pays on Charges with Calculated Amounts

When entering charges, the Quantity field defaults to 1, the Unit field displays the price per unit for the selected SIM code from the Service Items Library, and the Override field defaults to the price per unit. The Extended field displays the total amount for the charge, calculated as Quantity x Override = Extended. If you enter a Quantity that is greater than 1 or enters an override price per unit in the Override field, then the Extended amount is recalculated for the charge. The following table shows various charge scenarios and whether a co-pay will be applied to the charge. Is charge Quantity >1? Is charge Override price entered? Is charge Extended amount recalculated? Is Co-Pay applied to charge? No No No Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Note: When the charge Quantity is >1 and an Override price is entered, the Extended amount is recalculated only if the Calculate extended amount on overridden charges option is selected in Practice Preferences > Charge Entry. If

Help Guide for NextGen® Enterprise PM 8

Automatic Adjustments Overview

You can apply automatic adjustments at the time of charge posting to adjust the difference between the charge amount for a procedure and the allowed amount for the payer. Charge Amount - Allowed Amount = Adjustment Amount When you enter and save a charge on the Charge Posting window, the Contract can be linked to the payer (insurance) on the charge. If there is a contract linked to the payer, the CPT4 code for the charge is included in the Fee Schedule set up within the contract and the Automatically adjust charges option is enabled in the setup of the contract, then the automatic adjustment is applied to the charge. Automatic Adjustments - Additional Information You can use some additional information while working with automatic adjustments. Contract Automatic Adjustment Contract Adjustments on Charges with Calculated Amounts Reversing Automatic Adjustments You can reverse automatic adjustments on the Reverse Automatic Adjustments window. Reverse and Correct Auto-Adjustments after a

Help Guide for NextGen® Enterprise PM 8

Field Descriptions for Entering a Charge

Use the following table to complete the fields for each charge entered on the encounter. Field Description Svc Dates Defaults to the Billable Date found on the Encounter Maintenance window. The From and To dates can be modified, by entering the date (MM/DD/YYYY) or by selecting the date from the Calendar button. Note: The encounter Billable Date and the charge Service Date are typically the same. Svc Item You can do one of the following: Enter or select the SIM code from the list. Enter or select the SIM description from the list. You can leave this field blank and press the Tab key to move to the SIM description field on the right. Note: The Service Item code is not sent on claims. CPT4 Shows the CPT4 code linked to the selected SIM code. This field cannot be modified. Note: The CPT4 code is sent on claims. Modifiers 1 - 4 In the Modifier fields to the right of CPT4, you can enter up to four 2-digit modifiers for the charge, if needed. Quantity Defaults to 1 and can be modified, if ne

Contract Adjustments on Charges with Calculated Amounts

Recommendations

Automatic Adjustments - Additional Information

Reverse and Correct Auto-Adjustments after a Contract Change

Contract Automatic Adjustment

Co-Pays on Charges with Calculated Amounts

Automatic Adjustments Overview

Field Descriptions for Entering a Charge

Automatic Adjustments - Additional Information

Reverse and Correct Auto-Adjustments after a Contract Change

Contract Automatic Adjustment

Co-Pays on Charges with Calculated Amounts

Automatic Adjustments Overview

Field Descriptions for Entering a Charge