Billing Limitations Grid

NextGen® Therapy Suite Help 30.3.13.0

Financial Class Grid

Use the Financial Class grid to assign financial classes in your system to financial categories. Some of the programming in NextGen® Therapy Suite is done strictly off Financial Category. Include only financial classes that have specific billing rules that differ from standard AMA billing. For example, if BCBS has an overall limit of 4 billable units per visit and BCBS is currently in your Commercial Financial Class, you must create a separate financial class for BCBS so the application can apply the four-unit billing limitation to only BCBS and not the entire Commercial Financial Class. Financial Class grid Assign Financial Classes to Financial Categories Parent topic: Financial Class Setup

NextGen® Therapy Suite Help 30.3.13.0

Financial Class Setup

The Financial Class Setup panel has two grids: one to set up financial classes, and the other to configure billing limitations based on financial categories and payers. Financial Class Setup panel Financial Class Grid Billing Limitations Grid Parent topic: Billing Configuration

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

NextGen® Therapy Suite Help 30.3.13.0

Payer Specific Billing Panel

Use the grids in the Payer Specific Billing panel to configure any special payer-specific billing rules that you want to apply to a code selected in the Codes panel. Payer Specific Billing panel Payer Specific Adjustments Grid The Financial Category Replacement Code Prevent Billing Grid Modifiers Parent topic: Billing Configuration

NextGen® Orthopedic Suite Help 80.2.14.0

Enable a Financial Class for MIPS Quality Measures

You can add an eligible financial class for MIPS Quality measures. On the Billing Configuration practice template, expand the MIPS Quality Measures panel. In the field below the Eligible financial classes for MIPS Quality Measures reporting grid, select the financial class. Click Add. The financial class appears in the grid. Select the financial class in the Eligible financial classes for MIPS Quality Measures reporting grid to see all payers for that financial class, in the Payers in the list and Payers not in the list grids. Parent topic: MIPS Quality Measures

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

Billing Limitations Grid

Recommendations

Financial Class Grid

Financial Class Setup

Add a Billing Limitation

Payer Specific Billing Panel

Enable a Financial Class for MIPS Quality Measures

Configure Payer Exceptions to Allow Combined Medications

Financial Class Grid

Financial Class Setup

Add a Billing Limitation

Payer Specific Billing Panel

Enable a Financial Class for MIPS Quality Measures

Configure Payer Exceptions to Allow Combined Medications