Generate Cost Estimation

The default information appearing on the Estimate Patient Cost window depends on the source of the cost estimation. You can specify the necessary data such as provider information, service location, service type, service items, and units of service items required for estimating cost. Additionally, you can keep notes and assign diagnosis codes.

In NextGen® Enterprise PM, select Est Patient Cost on the toolbar.
The People Lookup window opens.
Double-click to select a person.
The Modify Person Information window opens.
You can make necessary changes to the person record and then select Ok.
The Estimate Patient Cost window opens for the selected person or patient.
On the Estimate Patient Cost window, to select the payer in the Payer Selection section, do one of the following:

Note: Payer Selection is a required field.
- If the person or patient wants to use insurance coverage for the services, select a payer from the list.
  Note: You can select only one payer from the list.
  If you select a payer, then the Self-Pay option is automatically cleared.
- If the person or patient wants to make the payment from their own pocket; does not have any insurance coverage; or chooses not to use insurance, select Self-Pay.
  Note: When you select Self-Pay, the payer list is not available for selection.
  
  Note: You can apply sliding fee only to self-paying patients.
Select the rendering provider, service location, and service type.

Note: Provider and Location are required fields.
In the Svc Item column of Service Items, do one of the following:
- To find a specific SIM code, type a part of the SIM code. You can select from the list of SIM codes by pressing the Tab and Enter keys, or by double-clicking the SIM code.
  Note: Expired SIM codes do not appear in the list.
- To display the SIM codes in a SIM group, type the SIM group. Select the desired SIM group from the list of SIM groups by pressing the Tab and Enter keys, or by double-clicking the SIM code.
- To search for the SIM code, select . The SIM Code Search window opens.
  - Under Search Method, select Code or Description to determine how you want the search results to be listed, then enter the search data by code or description.
  - Select the appropriate code, and then select OK.
The service item number and default description are displayed. The default description for the SIM is the same as the CPT®4 code description.
Type the applicable modifiers for the service item in the M1, M2, M3, and M4 columns.

When you select a SIM code mapped to aCPT®4 code with modifiers, the associated modifiers appear in the respective columns.
To estimate the cost for facility pricing, select the Facility check box.

Note: Pricing for services are different for facility and non-facility service locations.
In the Unit(s) column, type the number of units of the service.
By default, the unit for the service is 1.
Type your notes for the estimation in Estimation Notes.
You can add or remove diagnosis codes in the ICD-CM section. If you open the Estimate Patient Cost window from an encounter, the encounter-level diagnosis codes are displayed.
Select Submit.

Note: If your practice uses NextGen® EDIreal-time services, you can experience a wait time of 50 seconds when submitting an estimation.
- A cost estimate is created.
- A cost estimation ID is generated and displayed in Cost Estimation ID.
- The Charge Amt, Allowed Amt, Coins, Copay, Deductible, Adj Amt, and Non-Covered columns are filled.
  Note:
  
  The co-pay amount only appears for the first service item. You can manually type the co-pay for the subsequent service items.
  Note: If the co-pay amount appears for two service line items, it means that the two service items have the same CPT®4 code and co-pay amounts are sourced from contract exception or contract library.
  
  If multiple co-pay amounts are defined for a specialty in the insurance information, the co-pay amounts appear in Copay from where you can select one of them.
  
  If multiple coinsurance amounts are defined for a CPT®4 code or service type in the real-time response information, the coinsurance amounts appear in Coins from where you can select one of them.
- If a patient or person is eligible for sliding fee discount, the Adj Amt column displays the sliding fee discount provided for each service.
- The following values appear in the Estimated Cost section.
  - Copay
  - Deductible
  - Coinsurance
  - Non-Covered
  - Total Pat Est Amt
  - Estimated Charge
  - Estimated Allowed
  - Estimated Adjustment
  - Patient Resp Amount
  - Total Ins Est Amt
  - Percentage to Request
  - Min Amt to Request
  Note: If the patient or person is eligible for sliding fee discount, a message appears stating that sliding fee has been applied with the discount rates to the current estimation.
- The estimation notes and diagnosis codes are saved.
- The cost estimate is added to History as the first row for the person or patient.

In NextGen® Enterprise PM, select Est Patient Cost on the toolbar.
The People Lookup window opens.
Double-click to select a person.
The Modify Person Information window opens.
You can make necessary changes to the person record and then select Ok.
The Estimate Patient Cost window opens for the selected person or patient.
On the Estimate Patient Cost window, to select the payer in the Payer Selection section, do one of the following:

Note: Payer Selection is a required field.
- If the person or patient wants to use insurance coverage for the services, select a payer from the list.
  Note: You can select only one payer from the list.
  If you select a payer, then the Self-Pay option is automatically cleared.
- If the person or patient wants to make the payment from their own pocket; does not have any insurance coverage; or chooses not to use insurance, select Self-Pay.
  Note: When you select Self-Pay, the payer list is not available for selection.
  
  Note: You can apply sliding fee only to self-paying patients.
Select the rendering provider, service location, and service type.

Note: Provider and Location are required fields.
In the Svc Item column of Service Items, do one of the following:
- To find a specific SIM code, type a part of the SIM code. You can select from the list of SIM codes by pressing the Tab and Enter keys, or by double-clicking the SIM code.
  Note: Expired SIM codes do not appear in the list.
- To display the SIM codes in a SIM group, type the SIM group. Select the desired SIM group from the list of SIM groups by pressing the Tab and Enter keys, or by double-clicking the SIM code.
- To search for the SIM code, select . The SIM Code Search window opens.
  - Under Search Method, select Code or Description to determine how you want the search results to be listed, then enter the search data by code or description.
  - Select the appropriate code, and then select OK.
The service item number and default description are displayed. The default description for the SIM is the same as the CPT®4 code description.
Type the applicable modifiers for the service item in the M1, M2, M3, and M4 columns.

When you select a SIM code mapped to aCPT®4 code with modifiers, the associated modifiers appear in the respective columns.
To estimate the cost for facility pricing, select the Facility check box.

Note: Pricing for services are different for facility and non-facility service locations.
In the Unit(s) column, type the number of units of the service.
By default, the unit for the service is 1.
Type your notes for the estimation in Estimation Notes.
You can add or remove diagnosis codes in the ICD-CM section. If you open the Estimate Patient Cost window from an encounter, the encounter-level diagnosis codes are displayed.
Select Submit.

Note: If your practice uses NextGen® EDIreal-time services, you can experience a wait time of 50 seconds when submitting an estimation.
- A cost estimate is created.
- A cost estimation ID is generated and displayed in Cost Estimation ID.
- The Charge Amt, Allowed Amt, Coins, Copay, Deductible, Adj Amt, and Non-Covered columns are filled.
  Note:
  
  The co-pay amount only appears for the first service item. You can manually type the co-pay for the subsequent service items.
  Note: If the co-pay amount appears for two service line items, it means that the two service items have the same CPT®4 code and co-pay amounts are sourced from contract exception or contract library.
  
  If multiple co-pay amounts are defined for a specialty in the insurance information, the co-pay amounts appear in Copay from where you can select one of them.
  
  If multiple coinsurance amounts are defined for a CPT®4 code or service type in the real-time response information, the coinsurance amounts appear in Coins from where you can select one of them.
- If a patient or person is eligible for sliding fee discount, the Adj Amt column displays the sliding fee discount provided for each service.
- The following values appear in the Estimated Cost section.
  - Copay
  - Deductible
  - Coinsurance
  - Non-Covered
  - Total Pat Est Amt
  - Estimated Charge
  - Estimated Allowed
  - Estimated Adjustment
  - Patient Resp Amount
  - Total Ins Est Amt
  - Percentage to Request
  - Min Amt to Request
  Note: If the patient or person is eligible for sliding fee discount, a message appears stating that sliding fee has been applied with the discount rates to the current estimation.
- The estimation notes and diagnosis codes are saved.
- The cost estimate is added to History as the first row for the person or patient.

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