Medicare Certification Box
The fields in the Medicare box track certification period and therapy cap totals.
Recommendations
NextGen® Therapy Suite Help 30.3.13.0
Use the Script fields to record and track the date of scripts that the patient has referring them to the client for therapy or chiropractic care. If this is a Medicare patient, you also track the Plan of Care (POC) from the script fields. Script fields Enter an External Script Enter a New Internal Script Parent topic: Homepage TemplateScript Fields
NextGen® Therapy Suite Help 30.3.13.0
The Medicare Certification Period fields track the timeframe if Medicare is attached to the case. The date fields are populated when the POC is generated. They match the POC dates if the POC is 90 days or less. If the POC is greater than 90 days, the Medicare Certification Period cuts off at 90 days (or the timeframe configured in the System Config system template) to stay complaint with your state’s guidelines, and the system alerts you to update your POC. Medicare Certification Period date fields Parent topic: Medicare Certification BoxMedicare Certification Period
NextGen® Therapy Suite Help 30.3.13.0
KX Modifier tracking occurs automatically when you submit charges on encounters. The system looks to the Procedure Module or the Charges table in NextGen® Enterprise PM for any billable codes for the current encounter, and then, based on configuration set up, checks the payer’s contract in File Maintenance or in the Reimbursement Rate grid on the Billing Configuration system template for any codes with the GP, GO or GN modifier to calculate reimbursement for the current calendar year. In the Medicare Certification box on the NTS Homepage, the Used this year field displays the system-calculated value. In the corresponding Amt used field, you can manually enter any amount used externally in the same calendar year. KX Modifier amount fields After patient treatment charges pass the first-tier cap (as designated in the Billing Configuration system template), the system applies the KX modifier to all charges for the remainder of the calendar year. Parent topic: Medicare Certification BoxKX Modifier
NextGen® Therapy Suite Help 30.3.13.0
In the Medicare KX Mod Cap grid, select the entry you want to delete. Select Delete. Parent topic: Payer Reimbursement & Medicare Therapy CapDelete a Medicare KX Mod Cap
NextGen® Therapy Suite Help 30.3.13.0
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 CapAdd a Medicare KX Mod Cap
NextGen® Therapy Suite Help 30.3.13.0
Determine if the financial class should be tracking the Medicare Certification Period that is on Homepage. If you have Medicare payers in different financial classes, set up each of the financial classes to add dates to the Medicare Certification period on Homepage. Add the Financial Class. In the MCR Cert column select either Primary or Any option. Select the Add/Update button. This then tracks the Medicare Certification Period based on your longest goal or 90 days, whichever is shorter. For non-Medicare financial classes in this grid, enter No for the MCR Cert column. Any means if Medicare is primary, secondary or tertiary ins. Primary – primary only Parent topic: Finclass Settings