Location-Based Sliding Fee Scenario

Help Guide for NextGen® Enterprise PM 8

Encounter-Based and Line Item-Based Sliding Fees

In some cost estimation situations, a line-item based sliding fee adjustment can produce dramatically different estimated amounts for a patient or person than an encounter-based sliding fee adjustment as shown in the following examples. For example: If you apply a line-item based sliding fee adjustment with a minimum payment of $50 and a 90% discount to a patient or person encounter with estimated amounts of $150, $40, and $10, the adjustment applies the minimum payment to each estimated amount resulting in a total estimated amount of $150 to the patient or person. Note: When an adjustment results in an estimated amount that is less than the minimum payment, as in this example, the system overrides the adjustment and applies the minimum fees. The estimated amount cannot be less than the adjustment's minimum payment. If you apply an encounter-based sliding fee adjustment with the same discount and minimum payment to the encounter, the schedule takes the total of the estimated amount ($2

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

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

Sex-Based Sliding Fee Scenario

In the Sex field, you can select the gender as Male, Female, Undifferentiated, or Unknown. In the following example, the male gender is considered. The application applies the sliding fee schedule only for patients or encounters that have the patient gender as male. Parent topic: Sliding Fee in Cost Estimation

Help Guide for NextGen® Enterprise PM 8

Multiple Sliding Fee Schedules Scenario

A patient or an encounter may have multiple sliding fee schedules attached to it. The application follows a specific hierarchy to select the sliding fee schedule for cost estimation. Note: If a line-item based sliding fee is attached to a patient, and an encounter based sliding fee is attached to an encounter then the encounter level sliding fee takes precedence over the line-item based sliding fee. However, when cost estimation is launched from anywhere except an encounter, the line-item based sliding fee takes precedence. Scenario: Encounter Based Sliding Fee Takes Precedence An encounter based sliding fee takes precedence in cost estimation in the following scenarios. A line item based sliding fee is attached at the person or patient level, and an encounter based sliding fee is attached at the encounter level. Multiple encounter based sliding fee schedules are attached to an encounter. The schedule with the highest order of priority is applied. Multiple encounter based sliding fee s

Help Guide for NextGen® Enterprise PM 8

CPT®4 Range-Based Sliding Fee Scenario

You can select the CPT Codes range in the Sliding Fee Schedule Detail Maintenance window. The following example uses the CPT Code range of 99212 to 99213. The application applies the sliding fee schedule only on the range of CPT4 codes from 99212 to 99213. Sliding fee adjustment on the Estimate Patient Cost window. Parent topic: Sliding Fee in Cost Estimation

Location-Based Sliding Fee Scenario

Recommendations

Encounter-Based and Line Item-Based Sliding Fees

Patient and Encounter Level Sliding Fee Scenarios

Age Range-Based Sliding Fee Scenario

Sex-Based Sliding Fee Scenario

Multiple Sliding Fee Schedules Scenario

CPT®4 Range-Based Sliding Fee Scenario

Encounter-Based and Line Item-Based Sliding Fees

Patient and Encounter Level Sliding Fee Scenarios

Age Range-Based Sliding Fee Scenario

Sex-Based Sliding Fee Scenario

Multiple Sliding Fee Schedules Scenario

CPT®4 Range-Based Sliding Fee Scenario