Configuring Billing Codes

NextGen® Therapy Suite Help 30.3.13.0

Add a New DME Item

Do one of the following to add a DME type: To enter a new DME type, select the field below the Type column, and then type the name. To select a DME Types from a picklist, double-click in the field, and then select a type name. DME Types picklist opened from DME Supplies panel Select the field below the Item column. A picklist opens with any items listed in the SIM library. Select an item, and then select OK. The field displays the item, and the price and SIM code listed for the item in the SIM library appear in the Price and Code fields. Select Add. Note: When you update prices for supplies, updating them in the SIM library also updates the supplies in the NextGen® Therapy Suite templates. The DME Supplies grid displays the new row. As needed, open the Payer Specific Billing panel to assign replacement codes and modifiers and to prevent billing on any of the DME codes (see Payer Specific Billing Panel). Parent topic: DME Supplies Panel

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

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

Configure Order of Billing Codes

You can configure the order of the billing codes that appear in the Codes grid within the Code Type grouping. The sort order determines the order that the codes appear on the Fee Sheet and on the claim. 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. On the NTS Billing Config system template, expand the Codes panel. To order the codes based on the financial class and payer, select the financial class and payer. In the Codes grid, select the desired row. Select the up and down arrows below the grid to set the position of the code in the list within the code type grouping. Parent topic: Configuring Billing Codes

NextGen® Therapy Suite Help 30.3.13.0

Update Codes on NTS Billing Config Template

On the NTS Billing Config system template, expand the Codes panel. In the Codes grid, select the code you want to update. The details of the code appear in the fields below the grid. Make the desired changes. Select Add/Update. The code entry is updated in the grid. Parent topic: Configuring Billing Codes

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

Configuring Billing Codes

Recommendations

Add a New DME Item

Payer Specific Billing Panel

Payer Reimbursement & Medicare Therapy Cap

Configure Order of Billing Codes

Update Codes on NTS Billing Config Template

Add Codes on NTS Billing Config Template

Add a New DME Item

Payer Specific Billing Panel

Payer Reimbursement & Medicare Therapy Cap

Configure Order of Billing Codes

Update Codes on NTS Billing Config Template

Add Codes on NTS Billing Config Template