Set Up Patient Responsibility Schedules

Help Guide for NextGen® Enterprise PM 8

Set Up Poverty Percentages and Categories

You enter federal poverty guidelines by creating poverty percentages and by assigning poverty categories to the percentages. Once poverty percentages are set up, you can add them to: Patient Data Sheets and Fee Tickets in Practice Preferences > Data\Fee Ticket. Forms and labels in the Form Templates and Label Templates master files. To define poverty percentages, do the following: Access File Maintenance. Select System Master Files > Patient Responsibility. The Patient Responsibility Maintenance window opens. This window contains a table with columns and rows. If this is the first time you've opened the Patient Responsibility master file, the first column displays 100 in the first row for poverty percentage. The poverty percentages are entered in the first row across the top of the table. Poverty categories are listed in the second row. The family size, which is the total number of family members, is listed in the first column down the left side of the table. The family annual income i

Help Guide for NextGen® Enterprise PM 8

Apply Patient Responsibility Schedule to Payers

After you save a Patient Responsibility Schedule, you can configure the schedule for one or more specific payers. Only one active schedule can exist for a payer. If there is already an existing schedule for a payer, it must be expired before you can configure another schedule for that payer. To apply a patient responsibility schedule to payers, do the following: In the Patient Responsibility master file, select the applicable patient responsibility schedule row. Select the Open Menu button, and then select Payer Configurations. The Configure Payer window opens. If the schedule row applies to all payers, select the All Payers check box, and then select OK. To apply the row to specific payers, select the Open Menu button, and then select New. The Payers window opens. Use the arrows to move the items from the Available list to the Included list, and then select OK. Any selected payer names display on the Configure Payer window. Note: To remove a payer from the list, select the payer name

Help Guide for NextGen® Enterprise PM 8

Enable Patient Poverty Alerts

Two types of alerts can display in NextGen® Enterprise PM for patients whose family size and income fit within an active poverty percentage and patient responsibility schedule: Patient Responsibility alert Percent of Poverty alert The Patient Responsibility alert informs you that, based on the patient's head-of-household information, the patient is placed on a patient responsibility schedule. The alert includes the patient responsibility schedule name, percentage of patient responsibility, family size, income, poverty percentage, and poverty category. The Percent of Poverty alert informs you either of the following: If the patient has head-of-household information, the alert includes the poverty percentage, poverty category, family size, and income. This alert displays only when no payers have been configured for the patient responsibility schedule. Note: If payers have been configured, then the Patient Responsibility alert displays instead. If the patient lacks head-of-household infor

File Maintenance Help for NextGen® Enterprise 8

Set Up Patient Responsibility Schedules

The Patient Responsibility Schedule defines the percentage used in conjunction with a payer that requires the patient to be responsible for a certain percentage of the allowed amount. At charge entry, after all automatic adjustments, SIM exceptions, and contract exceptions are applied but before any sliding fee adjustments are applied, the Patient Responsibility percentage is used to distribute the remaining charge balance between the Ins1 bucket and the patient responsibility bucket. The distribution is based on the percentage determined by the patient's HOH family size and income. For example, if the patient's family size and income qualify for a 40% patient responsibility, a $100 charge balance splits to $60 in the Ins1 bucket and $40 in the patient responsibility bucket. The split also occurs when the ER SIM is inserted. You can create multiple patient responsibility schedules and then apply them to payers. To set up the patient responsibility percentages, do the following: Under t

Help Guide for NextGen® Enterprise PM 8

Set Up Patient Responsibility Schedules

The Patient Responsibility Schedule defines the percentage used in conjunction with a payer that requires the patient to be responsible for a certain percentage of the allowed amount. At charge entry, after all automatic adjustments, SIM exceptions, and contract exceptions are applied but before any sliding fee adjustments are applied, the Patient Responsibility percentage is used to distribute the remaining charge balance between the Ins1 bucket and the patient responsibility bucket. The distribution is based on the percentage determined by the patient's HOH family size and income. For example, if the patient's family size and income qualify for a 40% patient responsibility, a $100 charge balance splits to $60 in the Ins1 bucket and $40 in the patient responsibility bucket. The split also occurs when the ER SIM is inserted. You can create multiple patient responsibility schedules and then apply them to payers (refer to Apply Patient Responsibility Schedule to Payers). To set up the pa

File Maintenance Help for NextGen® Enterprise

Set Up Patient Responsibility Schedules

The Patient Responsibility Schedule defines the percentage used in conjunction with a payer that requires the patient to be responsible for a certain percentage of the allowed amount. At charge entry, after all automatic adjustments, SIM exceptions, and contract exceptions are applied but before any sliding fee adjustments are applied, the Patient Responsibility percentage is used to distribute the remaining charge balance between the Ins1 bucket and the patient responsibility bucket. The distribution is based on the percentage determined by the patient's HOH family size and income. For example, if the patient's family size and income qualify for a 40% patient responsibility, a $100 charge balance splits to $60 in the Ins1 bucket and $40 in the patient responsibility bucket. The split also occurs when the ER SIM is inserted. You can create multiple patient responsibility schedules and then apply them to payers (refer to Apply Patient Responsibility Schedule to Payers). To set up the pa

Set Up Patient Responsibility Schedules

Recommendations

Set Up Poverty Percentages and Categories

Apply Patient Responsibility Schedule to Payers

Enable Patient Poverty Alerts

Set Up Patient Responsibility Schedules

Set Up Patient Responsibility Schedules

Set Up Patient Responsibility Schedules

Set Up Patient Responsibility Schedules

Set Up Poverty Percentages and Categories

Apply Patient Responsibility Schedule to Payers

Enable Patient Poverty Alerts

Set Up Patient Responsibility Schedules

Set Up Patient Responsibility Schedules

Set Up Patient Responsibility Schedules