NextGen Knowledge Center

Set Up Sliding Fee Details

A sliding fee schedule master file consists of one or more detailed sliding fee schedules. Each detailed sliding fee schedule is created with specific parameters such as sliding fee mode, CPT®4 code ranges, and service locations. It also includes a grid that defines the discount percentages based on family size and annual income.

If you are a system administrator, you can add or modify a cost estimation sliding fee schedule.

  1. In File Maintenance, open System Master Files > PM > Sliding Fee Schedules.
    The Sliding Fee Schedules List window opens.
  2. Select the desired sliding fee schedule master, select open menu , and select Open.
    The Sliding Fee Schedule Maintenance window opens.
  3. In the Sliding Fee Schedules section, do one of the following:
    • To add a sliding fee schedule, select open menu and select New.
    • To modify an existing sliding fee schedule, select the item in the list, select open menu and select Open.
    The Sliding Fee Schedule Detail Maintenance window opens.
    Sliding Fee Schedule Detail Maintenance

  4. Type a descriptive name for the sliding fee schedule.
  5. Select the effective and expiration dates for the sliding fee schedule.
  6. In Family Size, select the number of Family Size rows to be displayed in the table at the bottom of the window.
    The default value is 10, the maximum value is 20, and the minimum value is 2.
  7. In Nbr of Columns, select the Percent of Discount columns to be displayed in the table below.
    The default value is 10, the maximum value is 20, and the minimum value is 2.
  8. For Schedule Fee Mode, select one of the following:
    • Line Item Based (default). A separate adjustment takes place after each service line item is entered on the encounter.
    • Encounter Based. A single adjustment takes place after all service item lines have been entered on the encounter.
  9. For Sliding Fee Mode section, select one of the following:
    • Minimum Value Mode (default). Estimated amounts are adjusted using the discount % for the person or patient’s family size and income. If an adjustment results in a balance that is less than the defined minimum value, the adjustment amount is reduced to ensure that the balance is equal to the minimum value.
    • Flat Rate Mode. Estimated amounts are adjusted to the defined flat rate amount regardless of the discount % for the person or patient’s family size and income.
    Min Value or Flat Rate appears in the header of the last column in the table.
  10. For Min / Flat Rate Value Mode, select one of the following:
    • By Family Size (default). A column is added at the right end of the table and, depending on the selected sliding fee mode, the column header is Min Val or Flat Rate.
    • By Percent/Flat Rate. A row is added at the bottom of the table and, depending on the selected sliding fee mode, the row header is Min Val or Flat Rate.
  11. For Associated CPT4 Codes, select one of the following:
    • All CPT4 Codes (default). The sliding fee schedule applies to all CPT®4 codes.
    • CPT4 Code Range. The sliding fee schedule applies only to specific CPT®4 code ranges.

    For more information on creating and defining CPT®4 code ranges, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise.

  12. In Sex, do one of the following:

    • If the sliding fee schedule applies to persons or patients of all genders, leave blank or select <none>.

    • If the sliding fee schedule applies only to persons or patients of a specific gender, select the appropriate option Male, Female, Undifferentiated, or Unknown if the sliding fee schedule applies only to persons or patients of a specific gender.

  13. In Age, do one of the following:
    • If the sliding fee schedule applies to persons or patients of all ages, leave blank or enter 0.
    • If the sliding fee schedule applies to persons or patients of a specific age group, enter an age range.
  14. In Service Location, do one of the following:

    • If the sliding fee schedule applies to all locations, leave blank.

    • If the sliding fee schedule applies only to specific locations, select one or more locations.
  15. In the Percent of Discount and Annual Family Income table, do the following:
    • In the column headings, enter the discount (adjustment) percentages in descending order from left to right. For example, 100, 75, 50, 25, 0.
    • In the Family Size rows, enter the annual income amounts in ascending order from left to right. For example, $0.00, $10,000, $20,000, $30,000, $40,000.
    • In Min Val or Flat Rate (column), enter the minimum value or flat rate amount for each family size row, if applicable.
    • In Min Value or Flat Rate (row), enter the minimum value or flat rate amount for each percent of discount column, if applicable.
  16. Select OK.