Understanding Schedule Fee Mode and Sliding Fee Mode

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 NextGen® Enterprise PM based on the Schedule Fee Mode and Sliding Fee Mode settings in File Maintenance.

Example 1: Line Item Based / Minimum Value Mode

A Line Item Based / Minimum Value Mode sliding fee schedule is linked to a patient in NextGen® Enterprise PM. The patient’s family size and annual income qualify them to receive a 100% discount down to a minimum value of $5.00.

A separate adjustment takes place after each charge is entered on the encounter. The charges are adjusted by 100%. However, since a 100% adjustment would result in a balance of $0.00 for each charge, which is less than the $5.00 minimum value, the adjustment amounts are reduced to ensure the balance on each charge is equal to the minimum value. An encounter with three charges will have a patient balance of $15.00.

Example 2: Encounter Based / Minimum Value Mode

An Encounter Based / Minimum Value Mode sliding fee schedule is linked to a patient in NextGen® Enterprise PM. The patient’s family size and annual income qualify them to receive a 100% discount down to a minimum value of $5.00.

A single adjustment takes place after all charges have been entered on the encounter. The charges are adjusted by 100%. However, since a 100% adjustment would result in a balance of $0.00 for the encounter, which is less than the $5.00 minimum value, the adjustment amounts are reduced to ensure the balance on the encounter is equal to the minimum value. An encounter with three charges will have a patient balance of $5.00.

Example 3: Line Item Based / Flat Rate Mode

A Line Item Based / Flat Rate Mode sliding fee schedule is linked to a patient in NextGen® Enterprise PM. The patient’s family size and annual income qualify them to receive a 50% discount with a flat rate of $15.00.

A separate adjustment takes place after each charge is entered on the encounter. The charges would normally be adjusted by 50%. However, since a $15.00 flat rate is defined in the sliding fee schedule, the 50% adjustment rate is ignored and adjustment amounts are applied to ensure the balance on each charge is equal to the flat rate. An encounter with three charges will have a patient balance of $45.00.

Example 4: Encounter Based / Flat Rate Mode

An Encounter Based / Flat Rate Mode sliding fee schedule is linked to a patient in NextGen® Enterprise PM. The patient’s family size and annual income qualify them to receive a 50% discount with a flat rate of $15.00.

A single adjustment takes place after all charges have been entered on the encounter. The charges would normally be adjusted by 50%. However, since a $15.00 flat rate is defined in the sliding fee schedule, the 50% adjustment rate is ignored and adjustment amounts are applied to ensure the balance on the encounter is equal to the flat rate. An encounter with three charges will have a patient balance of $15.00.