Add a Standard Billing Rule

NextGen® Medication Inventory Control Help 10.6.3.0

Add a Special Billing Rule

In the Medication Information Configuration grid, select the billable medication for which you want to add the 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. In the Medication Billing Rules panel, make sure that the option for Special Rules is selected. Select the field below the Financial Class column of the Billing Rules grid. 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 certain payers, 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

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

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

NextGen® Therapy Suite Help 30.3.13.0

Add a Billing Limitation

Select the field below the grid Financial Category column. A picklist opens. Select one of the Financial Categories you created in the Financial Class Setup grid, and then select OK. Select the Payer Name field. A list of payers for the selected Financial Category opens. Select a payer, and then select OK. Select the State field and select the appropriate state or select the asterisk, for all states. If the payer follows the Medicare Combine (MC) rule, select the MC Rule checkbox and then choose an option for whether the rule is applied by Time or Rate. If there is a billing unit cap for the financial class or payer, enter it in the Billing Cap field. Select Add/Update to add the billing limitation to the grid. Parent topic: Billing Limitations Grid

Add a Standard Billing Rule

Recommendations

Add a Special Billing Rule

Update Any Billing Rule

Configuring Billing Rules

Configure Payers That Do Not Bill for Medication Marked Billable

Configure Financial Classes That Do Not Allow Combining Medications

Add a Billing Limitation

Add a Special Billing Rule

Update Any Billing Rule

Configuring Billing Rules

Configure Payers That Do Not Bill for Medication Marked Billable

Configure Financial Classes That Do Not Allow Combining Medications

Add a Billing Limitation