Assign Reimbursement Rates

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

Configuring Billing Codes

The Codes grid in the Codes panel on the NTS Billing Config system template lists all possible codes on the therapy templates. All the listed codes are provided as billing guidelines and follow the coding guidelines. The codes are not payer specific, but you can customize them by payer in the Payer Specific Billing panel. You can sort codes within a specific code type. The sort order determines the order that the codes appear on the Fee Sheet template and the claim. This is a global setting for all practices. Note: If you are using NextGen® Clinical Message Manager, the order in NextGen® Clinical Message Manager overrides the code order if it does not match the order in the Codes panel. To configure payer-specific rules for the use of a code, select the code in this grid and then use the grids in the Payer Specific Billing Panel. Codes panel Add Codes on NTS Billing Config Template You can add a code using the fields below the Codes grid in the Codes panel on the NTS Billing Config sys

NextGen® Therapy Suite Help 30.3.13.0

Add Codes on NTS Billing Config Template

You can add a code using the fields below the Codes grid in the Codes panel on the NTS Billing Config system template. On the NTS Billing Config system template, expand the Codes panel. In the field under Desc, enter a description for the code. In the field under Code, enter the code. Select the field under Code Type. The Ainf Cpt Code Type picklist opens. Select the code type from the list, and then select OK. Enter the time rule, minimum time, and maximum units. Enter N.A. if the time rule is not applicable. Indicate if the code is subject to the Medicare Combine Rule. Select Add/Update. Parent topic: Configuring Billing Codes

File Maintenance Help for NextGen® Enterprise 8

Fields on the Fee Schedule Tab

Field Description Date Range Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000. Type Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time. Non-Facility/Facility Indicates whether the reimbursement for a service performed at a facility or non-facility service location. Allowed Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is sele

Help Guide for NextGen® Enterprise PM 8

Fields on the Fee Schedule Tab

Field Description Date Range Indicates the Effective date when the fee is to begin, and the Expiration date when the fee will end. The Date Range for the specific CPT4 code must fall within the date range for the contract as defined on the General tab. You can enter multiple date ranges for a CPT4 code in cases where you need to update your contract to meet new requirements. Note: The Fee Schedule rows display in descending date order by Effective Date. The most recent dates display first. Example: 01/01/2016 and then 01/01/2000. Type Specifies the Fee for Service (FFS) as the type of charge. Note: Capitated type is not supported at this time. Non-Facility/Facility Indicates whether the reimbursement for a service performed at a facility or non-facility service location. Allowed Indicates the amount allowed by the contract for the charge. An adjustment will be made between the charge amount and the allowed amount during charge entry if the Automatically adjust charges check box is sele

Assign Reimbursement Rates

Recommendations

Update a Reimbursement Rate

Payer Reimbursement & Medicare Therapy Cap

Configuring Billing Codes

Add Codes on NTS Billing Config Template

Fields on the Fee Schedule Tab

Fields on the Fee Schedule Tab

Assign Reimbursement Rates

Update a Reimbursement Rate

Payer Reimbursement & Medicare Therapy Cap

Configuring Billing Codes

Add Codes on NTS Billing Config Template

Fields on the Fee Schedule Tab

Fields on the Fee Schedule Tab