Multiple Sliding Fee Schedules Scenario

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

Encounter Level Sliding Fee 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 an encounter on the Encounter Maintenance window. The following table lists the encounter-level sliding fee scenarios, and their calculations. Level Schedule Fee Mode Sliding Fee Mode Min / Flat Rate Value Mode Calculations Encounter Line Item-based Minimum Value By Family Size The patient’s family size of one and an annual income of $20000 allows a 50% discount. A separate adjustment is made for each service line, and it gets adjusted by 50%. The application adjusts the balance on each charge to equal it to the minimum value resulting in a minimum amount of $20 to be paid by the patient. For more information, see Sliding Fee Calculations for Encounter Level Line Item Based Scenarios. Encounter Line Item-based Minimum Value By Percent/Flat Rate The patient’s family siz

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

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

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 Patient and Encounter Level Line Item Based Scenarios

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 an encounter on the Encounter Maintenance window. Patient and Encounter Level Line Item Minimum Value Based Scenario Sliding fee adjustment on the Estimate Patient Cost window. The encounter level sliding fee gets precedence over the patient chart level sliding fee. Patient and Encounter level line Item Flat Rate Based Scenario Sliding fee adjustment on the Estimate Patient Cost window. The encounter level sliding fee gets precedence over the patient chart level sliding fee. Parent topic: Patient and Encounter Level Sliding Fee Scenarios

Multiple Sliding Fee Schedules Scenario

Scenario: Encounter Based Sliding Fee Takes Precedence

Scenario: Line Item Based Sliding Fee Takes Precedence

Recommendations

Patient and Encounter Level Sliding Fee Scenarios

Encounter Level Sliding Fee Scenarios

Encounter-Based and Line Item-Based Sliding Fees

Location-Based Sliding Fee Scenario

Sliding Fee in Cost Estimation

Sliding Fee Calculations for Patient and Encounter Level Line Item Based Scenarios

Patient and Encounter Level Sliding Fee Scenarios

Encounter Level Sliding Fee Scenarios

Encounter-Based and Line Item-Based Sliding Fees

Location-Based Sliding Fee Scenario

Sliding Fee in Cost Estimation

Sliding Fee Calculations for Patient and Encounter Level Line Item Based Scenarios