Add a Special Billing Rule

NextGen® Medication Inventory Control Help 10.6.3.0

Add a Standard Billing Rule

In the Medication Information Configuration grid, select the billable medication for which you want to add a rule. A check mark appears next to the selected medication in the grid, and the drug name, J-Code and NDC number are displayed in blue text on the Medication Billing Rules panel header. Make sure that the option for Standard Rules is selected above the Billing Rules grid. Select the field below the Financial Class column. A picklist of financial classes opens. Select the financial class for the rule, or select the asterisk to set the rule for all financial classes, and select OK. A picklist of payers for the selected financial class opens. Select a payer, if you are setting the billing rule for only a certain payer, or select the asterisk (*) if you are setting the rule for all payers in the financial class, and select OK. Select the field below the Quantity column and enter a quantity. Select the field below the # of Billing Units column and enter a quantity. Select Add to add

NextGen® Medication Inventory Control Help 10.6.3.0

Update Any Billing Rule

You can update any billing rule. The steps are the same for both standard and special billing rules. Note: For the default all-payer rules, you cannot update the Financial Class or Payer name (these must remain as asterisks), but you can change the Quantity-to-Billing Unit ratio. In the Medication Information Configuration grid, select the medication for which you want to update the rule. Select the entry in the Billing Rules grid. The fields below the grid fill in. Change the field entries as needed. Select Update to save the changes to the grid. Parent topic: Configuring Billing Rules

NextGen® Medication Inventory Control Help 10.6.3.0

How Special Billing Rules are Applied

For medications that are billed using different J-Codes or J-Code combinations depending on the quantity given, you can configure special billing rules for the application to apply. NextGen Healthcare recommends that you configure a special billing rule for every quantity that you expect to dispense or administer. If a rule is configured for the quantity given, the application applies that rule and bills accordingly. If no rule is configured for the exact quantity given, the application calculates a combination of J-Codes to bill for that quantity, as follows: It bills the J-Code associated with the largest configured Special Rule quantity that is equal to or less than the dispensed or administered quantity. It subtracts the first billed quantity from the amount given. It then bills the J-Code associated with the largest amount in the Special Billing rules grid that is equal to or less than the remainder. It subtracts the next billed amount from the remainder. It runs iterations of bil

NextGen® Medication Inventory Control Help 10.6.3.0

Configuring Billing Rules

When a medication is added to the Medication Information Configuration grid, the Billing Rules grid displays a default standard rule and a default special rule that apply to all financial classes (as designated by an asterisk) and all payers,of 1:1 Quantity-to-Billing Unit. Standard Rules are ratios of billing units per quantity of medication given. There may be a single standard rule, or different rules defined for different financial classes or payers. Special Rules are ratios used for billing when the J-Code changes depending on the medication quantity given (For example, as for Depo-Medrol). You cannot remove either default all-payer rule, but you can: Edit the Quantity-to-Billing Unit ratio for a default all-payer rule Add either standard or special rules for individual financial classes and payers Update added rules Delete added rules Note: You cannot set up special rules for a medication for which you have already set up a standard rule, nor set up standard rules for a medicatio

NextGen® Medication Inventory Control Help 10.6.3.0

Configure Payers That Do Not Bill for Medication Marked Billable

For any billable medication selected in the Medication Information Configuration grid, you can set up financial class and payer exceptions who do not bill for that medication. In the Medication Information Configuration grid, select the billable medication for which you want to add the rule. The drug name, J-Code and NDC number for the selected medication are displayed in blue text on the Medication Billing Rules panel header. Select the field below the Financial Class column of the Payers that DO NOT bill for Medication marked Billable grid. The MLTS Medcfg Finclass Payer PL picklist window for financial classes opens. Select a financial class and select OK. The MLTS Medcfg Finclass Payer PL picklist window for payers opens. Select a payer and select OK. Note: For all payers, select the asterisk (*). Select Add. The Financial class/Payer entry is added to the grid. Parent topic: Medication Billing Rules Panel

NextGen® Medication Inventory Control Help 10.6.3.0

Configure Financial Classes That Do Not Allow Combining Medications

By default, the NextGen® Medication Inventory Control application combines quantities to calculate and send billing units for all medications that have the same NDC. You can configure financial classes and payers who do not allow combining medications, using the Financial Classes that DO NOT Allow Combining Meds grid and the two payers grids below it. In the Medication Information Configuration grid, select the billable medication for which you want to add the rule. The drug name, J-Code and NDC number for the selected medication are displayed in blue text on the Medication Billing Rules panel header. Select the field below the Financial Classes that DO NOT Allow Combining Meds grid. The MLTS Medcfg Finclass Payer PL picklist window for financial classes opens. Select a financial class and select OK. Select Add. The financial class is added to the grid. Payer Exceptions Configuration to Allow Combined Medications Parent topic: Medication Billing Rules Panel

Add a Special Billing Rule

Recommendations

Add a Standard Billing Rule

Update Any Billing Rule

How Special Billing Rules are Applied

Configuring Billing Rules

Configure Payers That Do Not Bill for Medication Marked Billable

Configure Financial Classes That Do Not Allow Combining Medications