Contract Automatic Adjustment

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You can reverse outdated adjustments to selected charges and replace existing adjustments with new adjustments calculated from the updated allowed amount in the contract.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

Reversing Automatic Adjustments

When you remove insurance from an encounter with automatic adjustments applied to charges from an assigned contract and there are no other posted or unposted transactions applied to the encounter, the automatic adjustments are applied to the encounter for the payer. The application reverses the adjustment and removes the insurance from the encounter. Note: The application applies new adjustments to applicable charges if you attach a new payer to the encounter that has a contract with auto adjustments for the charges. You can delete a primary insurance for an encounter that has an automatic adjustment applied to its charges from an assigned contract and the encounter has no other posted or unposted transactions applied to it. You can delete it by selecting Delete on the Insurance tab on the Patient Chart window. The automatic adjustments are applied to the encounter for the payer and the application reverses the adjustment and deletes the payer from the encounter. You can also void a ch

Help Guide for NextGen® Enterprise PM 8

Contract Adjustments 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 follows: Quantity x Override = Extended If the user enters a Quantity 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 chart shows various charge scenarios and whether a contract auto-adjustment will be applied to the charge: 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) 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 over

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

File Maintenance Help for NextGen® Enterprise 8

Charge Posting Window

The alerts message shows a $50.00 automatic adjustment, which is the difference between the charge amount and the allowed amount specified in the contract for this CPT4 code. Select . The Charge Posting window opens with the automatic adjustment. Parent topic: Set Up Auto Charge Adjustments for Non-Participating Providers

Contract Automatic Adjustment

Recommendations

Automatic Adjustments - Additional Information

Reverse and Correct Auto-Adjustments after a Contract Change

Reversing Automatic Adjustments

Contract Adjustments on Charges with Calculated Amounts

Automatic Adjustments Overview

Charge Posting Window

Automatic Adjustments - Additional Information

Reverse and Correct Auto-Adjustments after a Contract Change

Reversing Automatic Adjustments

Contract Adjustments on Charges with Calculated Amounts

Automatic Adjustments Overview

Charge Posting Window