CPT®4 Range-Based Sliding Fee Scenario

Help Guide for NextGen® Enterprise PM 8

Set Up Sliding Fee Details

A sliding fee schedule master file consists of one or more detailed sliding fee schedules. Each detailed sliding fee schedule is created with specific parameters such as sliding fee mode, CPT®4 code ranges, and service locations. It also includes a grid that defines the discount percentages based on family size and annual income. If you are a system administrator, you can add or modify a cost estimation sliding fee schedule. In File Maintenance, open System Master Files > PM > Sliding Fee Schedules. The Sliding Fee Schedules List window opens. Select the desired sliding fee schedule master, select open menu , and select Open. The Sliding Fee Schedule Maintenance window opens. In the Sliding Fee Schedules section, do one of the following: To add a sliding fee schedule, select open menu and select New. To modify an existing sliding fee schedule, select the item in the list, select open menu and select Open. The Sliding Fee Schedule Detail Maintenance window opens. Sliding Fee Schedule De

Help Guide for NextGen® Enterprise PM 8

Patient and Encounter Level Sliding Fee Scenarios

The following conditions are considered for cost estimation if sliding fee schedules are attached at both patient chart level and encounter level. If a cost estimation is launched from an encounter which has a sliding fee schedule attached, then the encounter level sliding fee takes precedence over patient chart level sliding fee schedule. If the cost estimation is launched from a patient appointment, and the appointment has an encounter attached to it, then any sliding fee schedule attached to this encounter takes precedence over a chart level sliding fee schedule. If a cost estimation is not launched from an encounter or an appointment attached to an encounter, the patient chart level sliding fee schedule takes precedence. You can set up the sliding fee schedule details using the parameters on the Sliding Fee Schedule Detail Maintenance window. A patient with a family size of one and an annual income of $20000 has a sliding fee attached using the UDS tab on the Modify Patient Informa

Help Guide for NextGen® Enterprise PM 8

Location-Based Sliding Fee Scenario

In the Service Location field, you can select a specific practice location. The application applies the sliding fee schedule only for patients or encounters that have the selected service location. Sliding fee adjustment in the Estimate Patient Cost window. The sliding fee is not applied as the location for the encounter is different from the service location set in the sliding fee schedule. Parent topic: Sliding Fee in Cost Estimation

Help Guide for NextGen® Enterprise PM 8

Age Range-Based Sliding Fee Scenario

You can select the age range to be applied to the selected sliding fee schedule. An age range of 0 to 50 years is considered in the following example. The application applies the sliding fee schedule only on patients or encounters in the specified age range of 0 to 50. The application applies the sliding fee schedule only for patient's in the selected age range. Parent topic: Sliding Fee in Cost Estimation

Help Guide for NextGen® Enterprise PM 8

Sliding Fee in Cost Estimation

The sliding fee program offers differential pricing with adjustments based on the annual income and family size of a patient or person. Sliding fee schedules are attached to a patient or person or a specific encounter or chart in NextGen® Enterprise PM. When you attach a sliding fee schedule to an encounter, a percentage of the estimated amount specified on the Estimate Patient Cost window is automatically adjusted. In cost estimation, a patient or person eligible for sliding fee adjustments can only use the self-pay mode of payment. In NextGen® Enterprise PM, you can do the following: Attach sliding fee schedules at the chart level or encounter level for a person or patient. Note: The system does not combine encounter level and chart level sliding fees while judging which to apply. Encounter level sliding fee always take precedence over chart level sliding fee. Apply multiple sliding fee schedules at an encounter level or chart level for a person or patient. Note: When you add multipl

Help Guide for NextGen® Enterprise PM 8

Sliding Fee Calculations for Person or Patient Level Line Item Based Scenarios

You can set up the sliding fee schedule details using the parameters on the Sliding Fee Schedule Detail Maintenance window. A patient with a family size of one and an annual income of $20000 has a sliding fee attached to the patient demographics using the UDS tab on the Modify Patient Information window. Sliding fee schedules are attached to the encounter on the Encounter Maintenance window. Line Item Based Minimum Value Mode Scenarios Sliding fee adjustment on the Estimate Patient Cost window. Service Item Estimated Charge Amount Adjustment Amount Patient Amount 99212 $200.00 $100 $100 99212 $200.00 $100 $100 Line Item Based Flat Rate Mode Scenarios Sliding fee adjustment on the Estimate Patient Cost window. Service Item Charge Amount Adjustment Amount Patient Amount 99212 $200.00 $190 $10 99212 $200.00 $190 $10 Parent topic: Person and Patient Level Sliding Fee Scenarios

CPT®4 Range-Based Sliding Fee Scenario

Recommendations

Set Up Sliding Fee Details

Patient and Encounter Level Sliding Fee Scenarios

Location-Based Sliding Fee Scenario

Age Range-Based Sliding Fee Scenario

Sliding Fee in Cost Estimation

Sliding Fee Calculations for Person or Patient Level Line Item Based Scenarios

Set Up Sliding Fee Details

Patient and Encounter Level Sliding Fee Scenarios

Location-Based Sliding Fee Scenario

Age Range-Based Sliding Fee Scenario

Sliding Fee in Cost Estimation

Sliding Fee Calculations for Person or Patient Level Line Item Based Scenarios