Set Up Multiple Procedure Discount
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Help Guide for NextGen® Enterprise PM 8
Multiple Surgery Discounting
If the payer is linked to a contract and the CPT® code is enabled for multiple procedure discounting, then the allowed amount is reduced. The discount is calculated in conjunction with the sequence of CPT®4 codes and the corresponding modifier percentage on the fee schedule. Important: Ensure that you have enabled Multiple Surgery for multiple procedure discount Ensure that the modifier reimbursement percentage for the sequence has been set When you want to apply multiple surgery discounts on the allowed amount, the following can be used as reference: In the File Maintenance contract library, you set the following: Facility and non-facility amounts for the CPT®4 codes in the Fee Schedule tab Sequence indicator and modifier percentage in the Modifier Reimbursement tab In NextGen® Enterprise PM's Estimate Patient Cost window, submit the CPT®4 code for cost estimation. The system fetches the fee that is scheduled for the CPT®4 code. Based on the sequence that the CPT®4 code has been enter
Help Guide for NextGen® Enterprise PM 8
Endoscopy Discounting
When endoscopic-related procedures are performed, the allowed amount is adjusted based on the amount of the base CPT®4 code. When you set the Multiple Proc Discounting field in the Fee Schedule, select Endoscopy and specify the base CPT®4 code. Allowed Amount for Multiple Endoscopy Procedures Allowed amount for multiple endoscopic procedures is determined by base CPT® code. Parent topic: Multiple Procedure Discounting in Cost Estimation
Help Guide for NextGen® Enterprise PM 8
Scenarios - Determining Allowed Amount
The following scenarios describe the hierarchy used by the system to compare CPT®4 codes and modifiers on the Estimate Patient Cost window to those in the contract library to determine the allowed amount to be used for a service. Extended CPT®4 code (greater than 5 characters) in both Cost Estimation and Contract Library Cost Estimation Contract Library CPT®4 Code Mod 1 Mod 2 Mod 3 Mod 4 Fee Schedule Tab Modifier Reimbursement Tab 453805951 59 51 453805951 5951 The system looks at the CPT®4 code from the cost estimation (453805951) and determines that it is greater than 5 characters. This indicates that the modifiers are built into the CPT®4 code. The system takes the CPT®4 code from cost estimation and does a lookup in the Contract Library > Fee Schedule. It finds that the value (453805951) and the allowed amount defined for the 9-digit CPT®4 code are used. The Contract Library > Modifier Reimbursement is ignored since the modifiers were included in the CPT®4 code that was found on th
Help Guide for NextGen® Enterprise PM 8
Multiple Procedure Discounting in Cost Estimation
Multiple procedure discounting refers to the payment reduction applied to the allowed amount if the rendering provider performs multiple procedures on a single patient. You can configure the percentage of reduction on the allowed amount in a particular sequence of the procedure in the File Maintenance contract library. Set Up Multiple Procedure Discount You can set the percentage of reduction in the allowed amount in a particular sequence in the contract library from File Maintenance. Multiple Surgery Discounting The allowed amount is reduced for CPT®4 codes enabled with multiple surgery discounts. The discount is calculated in conjunction with the sequence of CPT®4 codes and the corresponding modifier percentage on the fee schedule. Endoscopy Discounting Multiple procedure discounts for endoscopy work in conjunction with the multiple procedure discount and base CPT®4 code fields on the Fee Schedule tab. Scenarios - Determining Allowed Amount The system uses a hierarchy to compare CPT®
Help Guide for NextGen® Enterprise PM 8
Set Up Modifier Reimbursement
In File Maintenance, open Libraries > Contract Parent topic: Modifier Reimbursement in Cost Estimation
File Maintenance Help for NextGen® Enterprise 8
Multiple Procedure Discounting Tab
The Multiple Procedure Discounting tab is used to reduce the allowed amount by the percentage specified in the table according to the sequence of the procedure. The tab works in conjunction with the Multiple Proc Discount and Base CPT4 Code fields on the Fee Schedule tab. Parent topic: Access Contract Library Maintenance
