Contract Exceptions

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

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

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

Allowed Amounts Subcategory

The three columns that are grouped into the Allowed Amounts subcategory all relate to the Allowed Amount in the contract or contract exception. The values that display in these columns come from one of the following: Contracts Library Payment Entry System generated calculation 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 Allowed Amounts subcategory based on contracts. The second section explains the Allowed Amounts subcategory based on contract exceptions. Contracts Contract Exceptions Parent topic: Contractual Analysis Report

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

Contract Exceptions

Recommendations

Contracts

Adjustment Amounts Subcategories

Understanding the Contractual Analysis Report

Payment Amounts Subcategory

Allowed Amounts Subcategory

Automatic Adjustments Overview

Contracts

Adjustment Amounts Subcategories

Understanding the Contractual Analysis Report

Payment Amounts Subcategory

Allowed Amounts Subcategory

Automatic Adjustments Overview