Add a Billing Limitation

NextGen® Therapy Suite Help 30.3.13.0

Billing Limitations Grid

Use the Billing Limitations grid if you need to set up a Financial Category to handle different rules by State and to set billing caps for them. Billing Limitations grid Add a Billing Limitation Parent topic: Financial Class Setup

NextGen® Therapy Suite Help 30.3.13.0

Configure Payer-Specific Adjustments

Set up a payer that allows less than 8 minutes in order to bill a unit. Note: You must apply adjustments to each code for which they apply. Select a code in the CPT Codes grid (in the CPT Codes panel), that you want to apply the override to. This pulls that code into the fields above the grids in the Payer Specific Billing panel. Select the Finclass Name field under the Payer Specific Adjustments grid. This opens a picklist of all financial classes that have been configured for your organization. Select the financial class, and then select OK. Select the Payer Name field and select a payer name from the list. Enter in the Time Rule amount. Enter the new minimum time that the payer allows. If the payer has a maximum number of allowable units that differs from the standard, enter that in the Max Units field. Payer Specific Adjustments grid If Medicare is the secondary insurance, select the MC Rule checkbox. The system uses the payer-specific adjustments (minimum minutes) and then applies

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

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

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 Payer Exceptions to Allow Combined Medications

Select the financial class in the Financial Classes that DO NOT Allow Combining Meds grid. Select any payer that is an exception to the rule of not allowing medications to be combined, from the left-hand grid. Select the right-pointing arrow between the grids to move that payer to the Payers in Financial Class that Allow Combining Meds grid. Parent topic: Payer Exceptions Configuration to Allow Combined Medications

Add a Billing Limitation

Recommendations

Billing Limitations Grid

Configure Payer-Specific Adjustments

Add a Standard Billing Rule

Add a Special Billing Rule

Configure Payers That Do Not Bill for Medication Marked Billable

Configure Payer Exceptions to Allow Combined Medications

Billing Limitations Grid

Configure Payer-Specific Adjustments

Add a Standard Billing Rule

Add a Special Billing Rule

Configure Payers That Do Not Bill for Medication Marked Billable

Configure Payer Exceptions to Allow Combined Medications