Configure a Financial Category Replacement Code

NextGen® Therapy Suite Help 30.3.13.0

The Financial Category Replacement Code

You can use the Financial Category Replacement Code grid to replace a code if you have a payer that requires a code other than the standard. A few of these are already configured, such as for Electrical Stimulation: when the Financial Category/payer is Medicare, the system replaces the 97014 code with G0283. This can also be filtered down to a specific payer within a Financial Category to accommodate the need for some clients to have different Revenue Codes for PT vs OT on the claim forms, you can set replacement codes based on the modifier attached to codes (GP or GO modifiers). This enables you to have one set of codes for PT and a slightly different set for OT, each tied to the correct Revenue code. When the claim is generated, the actual code can be billed without the modified replacement code showing by setting up the code correctly in your SIM library. Configure a Financial Category Replacement Code Parent topic: Payer Specific Billing Panel

NextGen® Therapy Suite Help 30.3.13.0

Add a Modifier

You can add a modifier to any code in the Codes grid. Select the code that you want to add a modifier to. Select the field below the Mod column of the Modifiers grid, and then enter the modifier to be applied. Select the option for Cpt Code. Select the field below the Cpt Code Ind column. A picklist of codes opens. If a modifier is needed, do the following: Due to billing two therapies together, choose the code for the additional therapy – the one NOT selected from the CPT Code grid, and then select OK. On the code you selected from the CPT Code grid (for example, for a chiropractor who needs to apply an AT modifier to CMT codes and the payer is Medicare), select that same code from the list, and then select OK. Select the field below Financial Category column. A picklist of financial categories opens. Select a financial category from the picklist, and then select OK. Select the field below the Payer Name column and select a financial category from the picklist. Select Add to add the m

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® Therapy Suite Help 30.3.13.0

Assign Financial Classes to Financial Categories

Select the field below the Financial Class column. A picklist opens of all of the existing financial classes you currently have built in your system. Select the financial class, and then select OK. The selection enters the field. Select the field below Financial Category. A picklist opens. Do one of the following: To use an existing financial category, select it, and then select OK. To create a new financial category, select the blank at the top of the picklist, select OK, and then enter the name of the new category into the field. Select the Add button to add the Financial Class and its category to the grid. Parent topic: Financial Class Grid

NextGen® Orthopedic Suite Help 80.2.14.0

Configuring Preferences for Non-Billable Procedures

You can update the procedure information and configure financial classes and payers for various non-billable procedures. You can use the Non-billable panel on the Billing Configuration practice template to do the following for a non-billable procedure. Select a Current Procedural Terminology (CPT) code Select an International Classification of Diseases (ICD) code Manage financial classes that require specific ICD codes Manage payers in the exclusion list for a financial class Non-billable panel on the Billing Configuration template Selecting a procedure from the Procedures grid displays the description, CPT code, and ICD code in their corresponding fields, and you can update them as needed. You can also add or remove financial classes in the Financial Classes grid for the selected procedure. If you select an existing financial class from the Financial Classes grid, the applicable payers are displayed in their corresponding grids that help you manage the payers in the exclusion list for

NextGen® Orthopedic Suite Help 80.2.14.0

Manage Payers for Non-Billable Procedures

You can add or remove payers in the exclusion list for a financial class. For a financial class associated with a non-billable procedure, you can manage the exclusion list for payers that require specific International Classification of Diseases (ICD) codes to be sent for the procedure. On the Billing Configuration practice template, expand the Non-billable panel. Non-billable panel on the Billing Configuration template Select a procedure from the Procedures grid. The procedure description, Current Procedural Terminology (CPT) code, and ICD code are automatically filled in their corresponding fields, and the configured financial classes are displayed in the Financial Classes grid. Select a financial class from the Financial Classes grid. The payers associated with the financial class are displayed in their corresponding grids. To remove a payer from the exclusion list, do the following: Select a payer from the Payers in the exclusion list grid. Click the Right arrow icon icon. The sele

Configure a Financial Category Replacement Code

Recommendations

The Financial Category Replacement Code

Add a Modifier

Configure Payer-Specific Adjustments

Assign Financial Classes to Financial Categories

Configuring Preferences for Non-Billable Procedures

Manage Payers for Non-Billable Procedures

The Financial Category Replacement Code

Add a Modifier

Configure Payer-Specific Adjustments

Assign Financial Classes to Financial Categories

Configuring Preferences for Non-Billable Procedures

Manage Payers for Non-Billable Procedures