Sliding Fee Schedules

Help Guide for NextGen® Enterprise PM 8

Sliding Fee Schedules

Sliding Fee Schedules are typically used by Health Centers. They are linked to a patient or to a specific patient encounter in NextGen® Enterprise PM. Once linked, a percentage of the charge amounts entered on an encounter are automatically adjusted off. The percentage of the automatic adjustment is based on household family size and annual income. Sliding Fee Schedule adjustments are reported on the UDS Report. Multiple sliding fee schedules can be created if needed. For example, if the percentage discounts vary for medical, dental, vision and/or behavioral health services, separate schedules can be created for each. To use Sliding Fee Schedules in NextGen® Enterprise PM, the following setup must be completed: Create Transaction Codes in File Maintenance to be used for sliding fee adjustments. Create Sliding Fee Schedules in File Maintenance. Configure options in Practice Preferences > Sliding Fee to determine how sliding fee adjustments should function within the practice. Once Slidi

Help Guide for NextGen® Enterprise PM 8

Creating Sliding Fee Schedules

Before a Sliding Fee Schedule can be linked to a patient or encounter in NextGen® Enterprise PM, the schedule must first be created in File Maintenance. Each sliding fee schedule is configured by family size and percentage discount based on annual income. Multiple sliding fee schedules can be created if needed. For example, if the percentage discounts vary for medical, dental, vision and/or behavioral health services, separate schedules can be created for each. Set Up the Sliding Fee Schedule Master File Set Up the Sliding Fee Schedule Details Assign Practice Access to Sliding Fee Schedules Parent topic: Sliding Fee Schedules

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

File Maintenance Help for NextGen® Enterprise 8

Sliding Fee Schedules

The Sliding Fee Schedule master file enables you to: Create active sliding fee schedules. Activate NextGen® Enterprise PM alerts that: Indicate when patients have an associated sliding fee schedule. Notify users when certain information pertaining to the sliding fee schedule must be re-verified. Exempt certain service items from the sliding fee schedule. In NextGen® Enterprise PM, you can: Attach sliding fee schedules to a patient's chart. Apply a sliding fee schedule discount against patient responsibility charges and automatically calculate discounts based on the active Sliding Fee Schedule. Apply more than one sliding fee schedule to an encounter. Report on the sliding fee schedule adjustment discounts. The modes of applying a sliding fee schedule to a patient’s charges are: Line item-based. Encounter-based. The Sliding Fee Schedule Practice Preferences provide additional options that you can set on a per practice basis. Line Item Based Sliding Fee Schedule Encounter-Based Sliding F

Help Guide for NextGen® Enterprise PM 8

Sliding Fee Patient Report

The Sliding Fee Patient report in NextGen® Enterprise PM enables you to view a list of patients with Sliding Fee Schedules that have had sliding fee adjustments applied to charges. Sliding fee schedules may be used by Community Health Centers and other practices that write-off a percentage of charge amounts for patients that qualify for automatic adjustments based on their family size and annual income. This demographics-based report lists patients that meet the following criteria: The patient has a Head of Household (HOH) selected in their chart. The HOH has family information entered and a sliding fee schedule selected. The patient has one or more encounters within the date range specified on the report filter. Sliding fee auto-adjustments were applied to charges on those encounters. By default, the report includes only patient with self-pay encounters. To include other patients, select the Include patients with insurance check box on Filter 1. Note: This report is not intended to ma

Help Guide for NextGen® Enterprise PM 8

Understanding Schedule Fee Mode and Sliding Fee Mode

This section provides more information on the Schedule Fee Mode and Sliding Fee Mode options on the Sliding Fee Schedule Detail Maintenance window and provides examples of how they work together. Schedule Fee Mode Select one of the following options: Line Item Based: A separate adjustment takes place after each charge is entered on the encounter. Encounter Based: A single adjustment takes place after all charges have been entered on the encounter. Sliding Fee Mode Select one of the following options: Minimum Value Mode: Charges are adjusted using the discount % for the 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 the balance is equal to the minimum value. Flat Rate Mode: Charges are adjusted to the defined Flat Rate amount regardless of the discount % for the patient’s family size and income. Examples The following examples describe how a Sliding Fee Schedule works in Next

Sliding Fee Schedules

Recommendations

Sliding Fee Schedules

Creating Sliding Fee Schedules

Sliding Fee in Cost Estimation

Sliding Fee Schedules

Sliding Fee Patient Report

Understanding Schedule Fee Mode and Sliding Fee Mode

Sliding Fee Schedules

Creating Sliding Fee Schedules

Sliding Fee in Cost Estimation

Sliding Fee Schedules

Sliding Fee Patient Report

Understanding Schedule Fee Mode and Sliding Fee Mode