Payer Reimbursement & Medicare Therapy Cap

NextGen® Therapy Suite Help 30.3.13.0

Configuring Billing Codes

The Codes grid in the Codes panel on the NTS Billing Config system template lists all possible codes on the therapy templates. All the listed codes are provided as billing guidelines and follow the coding guidelines. The codes are not payer specific, but you can customize them by payer in the Payer Specific Billing panel. You can sort codes within a specific code type. The sort order determines the order that the codes appear on the Fee Sheet template and the claim. This is a global setting for all practices. 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. To configure payer-specific rules for the use of a code, select the code in this grid and then use the grids in the Payer Specific Billing Panel. Codes panel 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 sys

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

NextGen® Therapy Suite Help 30.3.13.0

Billing Configuration

Use the NTS Billing Config system template panels to configure how charges are displayed on the Fee Sheet. Billing Configuration template Financial Class Setup Visit Type Setup Panel Configuring Billing Codes You can configure all the settings related to billing codes in the Codes panel on the NTS Billing Config system template. DME Supplies Panel Payer Specific Billing Panel Field Lookup (NextGen Only) Panel Payer Reimbursement & Medicare Therapy Cap Billing Provider Override & Facility Billing Panel Cancel, Ancillary Services & HA Repair Delivery Therapist Assistant Time Panel Parent topic: Configuring NextGen Therapy Suite

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

NextGen® Therapy Suite Help 30.3.13.0

KX Modifier

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 Box

NextGen® Therapy Suite Help 30.3.13.0

Update a Reimbursement Rate

Select the field above the Payer Reimbursement grid. A picklist of payers opens. Select the payer from the list, and then select OK. Select the therapy in the Payer Reimbursement grid. The code enters the field above the center (rates) grid, and any configured rates are shown in the grid. Payer Reimbursement grids Select a rate in the center grid. Edit the rate or either date in the fields below the grid. Edit the rate or either date in the fields below the grid. Select Update. Parent topic: Payer Reimbursement & Medicare Therapy Cap

Payer Reimbursement & Medicare Therapy Cap

Recommendations

Configuring Billing Codes

Assign Reimbursement Rates

Billing Configuration

Add a Medicare KX Mod Cap

KX Modifier

Update a Reimbursement Rate