Exempt Patient Co-Payments

Help Guide for NextGen® Enterprise PM 8

Exempt Patient Co-Payments

You can configure an encounter to exempt the patient from having to make a co-payment. When you make a patient's co-payment exempt, the application does not apply the co-payment amount to the patient amount due. When a patient is exempt from making a co-payment, the Charge Entry window still displays the patient co-pay responsibility that would have applied, but the co-pay amount is not included in the patient amount. Open Chart Lookup, access the patient chart, select Encounters > Insurance tab, and double-click on the payer in the Encounter Insurance list. The Insurance Maintenance window opens. Enable the Co-pay Exempt check box. Note: If the Co-pay Exempt field does not display on the Insurance Maintenance window, use the following procedure to activate it. To display the Co-pay Exempt field on Insurance Maintenance window, open the Chart Practice Preferences, and then enable the Enable encounter payer co-pay check box. Parent topic: Generating Secondary Electronic Claims

Help Guide for NextGen® Enterprise PM 8

Enter a Co-Pay Amount

On the Detail tab in the Insurance Maintenance window , there are several fields available for co-pay amounts. The amount entered indicates the patient's co-pay for the insurance, and the patient is responsible to pay that amount on encounters the insurance is linked to. Access the Insurance Maintenance window for the patient's insurance. Select the Detail tab. In the lower-right section of the window, enter a co-pay amount in the appropriate fields, as indicated below. Enterprise-Level Co-Pay In the Co-Pay Amount field, enter a dollar amount, or select a pre-defined co-pay amount from the drop-down list. This will be the patient's default co-pay for all encounters in all practices in the enterprise. Note: The enterprise-level Co-Pay Amount field is available only if the Enable practice payer specific information option is not selected in Practice Preferences > Chart. This allows all practices to use the same co-pay amount for the same patient/insurance. For example, all practices are

Help Guide for NextGen® Enterprise PM 8

Enter a Co-Pay Amount

On the Detail tab in the Insurance Maintenance window , there are several fields available for co-pay amounts. The amount entered indicates the patient's co-pay for the insurance, and the patient is responsible to pay that amount on encounters the insurance is linked to. Access the Insurance Maintenance window for the patient's insurance. Select the Detail tab. In the lower-right section of the window, enter a co-pay amount in the appropriate fields, as indicated below. Enterprise-Level Co-Pay In the Co-Pay Amount field, enter a dollar amount, or select a pre-defined co-pay amount from the drop-down list. This will be the patient's default co-pay for all encounters in all practices in the enterprise. Note: The enterprise-level Co-Pay Amount field is available only if the Enable practice payer specific information option is not selected in Practice Preferences > Chart. This allows all practices to use the same co-pay amount for the same patient/insurance. For example, all practices are

Help Guide for NextGen® Enterprise PM 8

Encounter-Level Co-Pay

If a zero ($0.00) or positive amount ($20.00) is found in the Enc Co-payment field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for that encounter only. If the Enc Co-payment field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Enc Co-Payment field on the Insurance Maintenance window is available only if the Enable encounter payer copay option is selected in Practice Preferences > Chart. This allows an encounter level co-pay amount to be entered that overrides the practice level co-pay amount for all other encounters. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Encounter-Level Co-Pay

If a zero ($0.00) or positive amount ($20.00) is found in the Enc Co-payment field on the Insurance Maintenance window, the defined amount will be the patient’s co-pay for that encounter only. If the Enc Co-payment field is blank, the system continues to the next step in the hierarchy to derive the co-pay amount. Note: The Enc Co-Payment field on the Insurance Maintenance window is available only if the Enable encounter payer copay option is selected in Practice Preferences > Chart. This allows an encounter level co-pay amount to be entered that overrides the practice level co-pay amount for all other encounters. Parent topic: Co-Pay Amount Hierarchy

Help Guide for NextGen® Enterprise PM 8

Viewing Insurance Information in Encounters

You can view a patient's insurance information in the Insurance tab You can view insurance information for an encounter in the Insurance tab under Encounters. The Encounters section displays the list of patient encounters. The Insurance Information section displays information for the selected insurance based on the setup for the payer in the payers master file in File Maintenance. For more information on setting up payers, go to NextGen Healthcare Success Community and download the latest File Maintenance Master Files Guide for NextGen® Enterprise PM. You can do the following on the Insurance tab under Encounters: Open the Encounter Insurance Selection window for the selected encounter. Open the Insurance Maintenance window for the encounter. Remove the selected insurance from the encounter. Open the Balance Control window for the selected encounter. Open the Authorization Listing window for the selected insurance. Open the Referral Listing window for the selected insurance. Open the

Exempt Patient Co-Payments

Recommendations

Exempt Patient Co-Payments

Enter a Co-Pay Amount

Enter a Co-Pay Amount

Encounter-Level Co-Pay

Encounter-Level Co-Pay

Viewing Insurance Information in Encounters

Exempt Patient Co-Payments

Exempt Patient Co-Payments

Enter a Co-Pay Amount

Enter a Co-Pay Amount

Encounter-Level Co-Pay

Encounter-Level Co-Pay

Viewing Insurance Information in Encounters