KX Modifier

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

Track KX Modifier in EPM

If set to Yes, it enables you to calculate the total used amount if you are using NextGen® Enterprise PM for billing. If set to No, the application tallies up the used amount from what is billed on Fee Sheet instead of looking to the patient charges table. Parent topic: Fee Sheet

NextGen® Therapy Suite Help 30.3.13.0

Add a Medicare KX Mod Cap

The Medicare KX Mod Cap grid shows the yearly caps for your Medicare total used amounts. Use the fields below the grid to enter or update a new yearly cap for Medicare KX Mod. Medicare KX Mod Cap grid Select the field below the Year column to enter the calendar year that the cap applies to. Select the fields below the PT SLP Cap 1 and PT SLP Cap 2columns to enter the 1st and 2nd tier caps for PT/SLP. Select the fields below the OT Cap 1 and OT Cap 2 columns to enter the 1st and 2nd tier caps for OT. Select Add/Update. Parent topic: Payer Reimbursement & Medicare Therapy Cap

Help Guide for NextGen® Enterprise PM 8

Retrieving Co-pay for Cost Estimation

If the practice is running in a real-time system, the system fetches the co-pay amount in the real-time eligibility (271) transaction file. If multiple co-pay amounts are found in the eligibility verification response, they are listed in the Estimate Patient Cost window. If your practice is running in a non-real-time system, the co-pay amount is obtained from the Insurance Maintenance window, Contract Exception Maintenance window, or Contract Library Maintenance window, based on a particular hierarchy system. Co-Pay from Insurance Information Based on the co-pay settings in the Payers master file in File Maintenance, co-pay amounts appear on the Insurance Maintenance window in NextGen® Enterprise PM. Your administrator must enable multiple co-pays by opening the Enterprise Preferences window, the General tab, and selecting the Enable multiple co-pays check box. On the Insurance Maintenance window, the co-pay amounts for cost estimation are as follows: Speciality co-pay information, suc

Help Guide for NextGen® Enterprise PM 8

Patient Cost Estimation Workflow

The cost estimation feature enables you to use the information within the application to provide an insight into the various costs associated with the different types of care. A practice, running in a real-time system, has a valid NextGen® Eligibility Verification license and is able to communicate with the real-time server. When an eligibility transaction is run, the system receives real-time eligibility (271) transaction file as response. A practice, running in non-real-time system, does not have a valid NextGen® Eligibility Verification license and retrieves values from the local database. If you are the administrator, you must complete the following configurations in File Maintenance. Set up payers in the payer master Set up providers in the provider master Set up the pricing for service item (SIM) codes and associate SIM codes with CPT®4 codes in the SIM library You can configure the following as needed and are not mandatory. Set up sliding fee schedules in the sliding fee schedul

NextGen® Therapy Suite Help 30.3.13.0

Set Up Assistant Time Modifiers

Select the Location Name field below the Modifier Configuration grid. Select the location, and then select OK. To have this modifier apply at all locations, select the “*”. Select the Financial Class field, and then select the financial class. Select the Payer Name field, and then select the payer name. Select the Visit Set field, and then select a visit set. Enter an Effective Date. In the Assist % field, specify the minimum percentage of the total code time that an Assistant must perform in order for the modifier to be applied on the Fee Sheet. Enter the modifier in the Mod field. In the Rate Diff field, specify the reimbursement reduction rate for any codes with the Assistant Modifier attached. The reduced amount is then added to the yearly totals for KX modifier tracking. Select Add. Parent topic: Therapist Assistant Time Panel

KX Modifier

Recommendations

Payer Reimbursement & Medicare Therapy Cap

Track KX Modifier in EPM

Add a Medicare KX Mod Cap

Retrieving Co-pay for Cost Estimation

Patient Cost Estimation Workflow

Set Up Assistant Time Modifiers

KX Modifier

Payer Reimbursement & Medicare Therapy Cap

Track KX Modifier in EPM

Add a Medicare KX Mod Cap

Retrieving Co-pay for Cost Estimation

Patient Cost Estimation Workflow

Set Up Assistant Time Modifiers