Configure Payer-Specific Adjustments

NextGen® Therapy Suite Help 30.3.13.0

Payer Specific Adjustments Grid

Some payers do not follow standard coding guidelines regarding the 8-minute rule. For example, a payer may allow a unit to be billed after five minutes of treatment. To accommodate this, use the Payer Specific Adjustments grid to override the 8-minute minimum for a whole financial class or for just a single payer within a financial class. Configure Payer-Specific Adjustments Parent topic: Payer Specific Billing Panel

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

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 a Financial Category Replacement Code

Select the code in the CPT Codes grid (in the CPT Codes panel) that you want to apply a replacement code for. Select the Financial Category field under the Financial Category Replacement Code grid. CPT Codes panel and Payer Specific Billing panel A picklist opens, of all financial categories that have been configured for your organization. Select the financial category, and then select OK. If this replacement only applies to a specific payer within a financial category, select the Payer Name field and select a payer from the list. Otherwise leave this field blank, and the replacement code will apply to all payers within that financial class. If this replacement applies only to a specific visit set, select the Visit Set field, and then select the visit set. Otherwise leave this field blank. Enter the replacement code into the Replacement Cpt Code field. Select Add/Update. The new entry appears in the grid. Parent topic: The Financial Category Replacement Code

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® 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

Configure Payer-Specific Adjustments

Recommendations

Payer Specific Adjustments Grid

Add a Billing Limitation

Add a Modifier

Configure a Financial Category Replacement Code

Payer Specific Billing Panel

Assign Reimbursement Rates

Payer Specific Adjustments Grid

Add a Billing Limitation

Add a Modifier

Configure a Financial Category Replacement Code

Payer Specific Billing Panel

Assign Reimbursement Rates