Patient Cost Estimation Workflow

Help Guide for NextGen® Enterprise PM 8

Cost Estimation Data Sources

The information for cost estimation can be retrieved from: Service Items (SIM) library A library that enables you to add SIM codes with associated CPT®4 code for each practice, along with prices. You can also group service items under one main number or name. SIM exception A library that enables you to charge different fees according to provider, location, and payer. Additional fees are referred to as exceptions, which can be set up and maintained through the SIM Library. Contract library A library that enables you to set up payers for the contract and indicates the reimbursement amount for the procedures. Contract exception A library that enables you to charge different fees based on the provider, location, and payer. Each additional fee is referred to as an exception to the contract and can be set up and maintained through the Contract library. After the exceptions are set up, you can assign a contract exception to providers at the provider, payer, or location level to apply the exce

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

Configuring Pre-Services Practice Preferences

Before you perform or complete the cost estimation in NextGen® Enterprise PM, your administrator can set the preferences for Pre-Services in the Practice Preferences window. However, setting the practice preferences is not mandatory. If you are an administrator, your preferred selections for pre-services determine the following values in cost estimation: Percentage of payment that the patient agrees to pay in advance Co-pay or deductible values in the patient's insurance information Allowed amount Coinsurance amount For descriptions of the fields for the Pre-Services preferences, go to the NextGen Healthcare Success Community and download the File Maintenance Preferences Guide forNextGen®Enterprise. Set Payment Preferences for Pre-Services Your administrator can set payment preferences that determines the amount the patient can pay in advance and update the insurance information. Configuring Practice Preferences for Allowed Amount The allowed amount can be retrieved from contracts and

Help Guide for NextGen® Enterprise PM 8

Estimating Patient Cost

In NextGen® Enterprise PM, the Estimate Patient Cost window enables you to specify the inputs required for calculating the patient and insurance responsibility amounts for services planned or rendered. You can initiate cost estimation from: The People Lookup window for a person. The Patient Lookup window for a patient. The Appointment Lookup window or the appointment book for an appointment or event. The Encounter Lookup window or the Encounters tab on the Patient Chart window for an encounter. The Estimation Results in the Clinical History/Notes tab on the Patient Chart window. When you initiate the cost estimation, the Estimate Patient Cost window opens: Every time you specify and submit data on the Estimate Patient Cost window, a new cost estimation record will be created with a unique cost estimation ID. Multiple cost estimates can be created for one person, patient, appointment, or encounter. Estimate Patient Cost Fields Details are provided for the fields that define the distribu

Help Guide for NextGen® Enterprise PM 8

Pre-Services Cost Estimation

NextGen® Enterprise PM offers a pre-service solution that offers clear estimation for planned or completed services. You can perform patient cost estimation if you have administrator privileges to perform administration tasks for the practice. The cost estimation feature enables you to: Obtain a breakdown of financial responsibilities between the patient and insurance provider. Inform the patient about the amount payable by the patient before or after using the services and the amount that will be settled by the insurance provider. Collect timely payments from the person or patient. Print cost estimation results in customized formats. Keep plain text notes for the estimation. Associate diagnosis code for the estimation. View previous cost estimates. Visit the account profile, patient balance, and chart of the person or patient from the cost estimation. Generate and view cost estimate reports. Patient Cost Estimation Workflow After your administrator configures the library and master fi

Help Guide for NextGen® Enterprise PM 8

Retrieving Co-pay for Cost Estimation

If the practice is running in a real-time system, the system fetches the co-pay amount in the real-time eligibility (271) transaction file. If multiple co-pay amounts are found in the eligibility verification response, they are listed in the Estimate Patient Cost window. If your practice is running in a non-real-time system, the co-pay amount is obtained from the Insurance Maintenance window, Contract Exception Maintenance window, or Contract Library Maintenance window, based on a particular hierarchy system. Co-Pay from Insurance Information Based on the co-pay settings in the Payers master file in File Maintenance, co-pay amounts appear on the Insurance Maintenance window in NextGen® Enterprise PM. Your administrator must enable multiple co-pays by opening the Enterprise Preferences window, the General tab, and selecting the Enable multiple co-pays check box. On the Insurance Maintenance window, the co-pay amounts for cost estimation are as follows: Speciality co-pay information, suc

Patient Cost Estimation Workflow

Recommendations

Cost Estimation Data Sources

Sliding Fee in Cost Estimation

Configuring Pre-Services Practice Preferences

Estimating Patient Cost

Pre-Services Cost Estimation

Retrieving Co-pay for Cost Estimation

Cost Estimation Data Sources

Sliding Fee in Cost Estimation

Configuring Pre-Services Practice Preferences

Estimating Patient Cost

Pre-Services Cost Estimation

Retrieving Co-pay for Cost Estimation