Add a Medicare KX Mod Cap

NextGen® Therapy Suite Help 30.3.13.0

Delete a Medicare KX Mod Cap

In the Medicare KX Mod Cap grid, select the entry you want to delete. Select Delete. Parent topic: Payer Reimbursement & Medicare Therapy Cap

NextGen® Therapy Suite Help 30.3.13.0

Assign Reimbursement Rates

In the NTS Billing Config system template, expand the Payer Reimbursement & Medicare Therapy Cap panel. Payer Reimbursement & Medicare Therapy Cap panel Select the field above the Payer Reimbursement grid. A picklist of payers opens. Note: To see a list of Financial Classes in the Payer Reimbursement grid, you must clear the Use Contract Rates checkbox on the NTS Practice Config template in the Fee Sheet section. Select the payer from the list, and then select OK. Codes for the selected payer fill the Payer Reimbursement grid. Select a code in the grid. The code for that service enters the field above the center grid. In the boxes below the center grid, add the Rate, the Effective date (MM/DD/YYYY) and the Expiration date (MM/DD/YYYY). Select the Add button. The rate is added to the Payer Reimbursement grid. If the effective date is a date in the future and there is no current rate exists, the Rate column will show an asterisk for the code. If a rate already exists, your new rate will

NextGen® Therapy Suite Help 30.3.13.0

Update a Reimbursement Rate

Select the field above the Payer Reimbursement grid. A picklist of payers opens. Select the payer from the list, and then select OK. Select the therapy in the Payer Reimbursement grid. The code enters the field above the center (rates) grid, and any configured rates are shown in the grid. Payer Reimbursement grids Select a rate in the center grid. Edit the rate or either date in the fields below the grid. Edit the rate or either date in the fields below the grid. Select Update. Parent topic: Payer Reimbursement & Medicare Therapy Cap

NextGen® Therapy Suite Help 30.3.13.0

Payer Reimbursement & Medicare Therapy Cap

The payer reimbursement rate is used to calculate the Medicare Cap usage and to determine optimal billing when payers have a billing cap configured in the Financial Class Setup panel. For example, if a payer has a 4-unit cap, this may result in the need to throw out a code. So, the system looks at the configured reimbursement rates to determine optimal billing. If you are using contracts in File Maintenance and have them turned on on the NTS Practice Config practice template, the system looks to those for the reimbursement rates. If you are not using contracts in File Maintenance, you must assign payer reimbursement rates so that in the event of a tie, and to prevent under-billing, the system can determine which code to send. All reimbursement rates are assigned to Financial Classes. You must indicate the reimbursement rates for all Financial Classes within the Financial Categories that have been assigned specific billing limitation in the NTS Billing Config template. Assign Reimbursem

NextGen® Therapy Suite Help 30.3.13.0

KX Modifier

KX Modifier tracking occurs automatically when you submit charges on encounters. The system looks to the Procedure Module or the Charges table in NextGen® Enterprise PM for any billable codes for the current encounter, and then, based on configuration set up, checks the payer’s contract in File Maintenance or in the Reimbursement Rate grid on the Billing Configuration system template for any codes with the GP, GO or GN modifier to calculate reimbursement for the current calendar year. In the Medicare Certification box on the NTS Homepage, the Used this year field displays the system-calculated value. In the corresponding Amt used field, you can manually enter any amount used externally in the same calendar year. KX Modifier amount fields After patient treatment charges pass the first-tier cap (as designated in the Billing Configuration system template), the system applies the KX modifier to all charges for the remainder of the calendar year. Parent topic: Medicare Certification Box

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 Medicare KX Mod Cap

Recommendations

Delete a Medicare KX Mod Cap

Assign Reimbursement Rates

Update a Reimbursement Rate

Payer Reimbursement & Medicare Therapy Cap

KX Modifier

Add a Billing Limitation

Delete a Medicare KX Mod Cap

Assign Reimbursement Rates

Update a Reimbursement Rate

Payer Reimbursement & Medicare Therapy Cap

KX Modifier

Add a Billing Limitation