Payer Specific Adjustments Grid

NextGen® Therapy Suite Help 30.3.13.0

Prevent Billing Grid

Use this grid to: Specify any payers, financial categories, or other codes that would make the selected code unbillable. Set alerts that warn users of payer-specific coding restrictions. These alerts appear on treatment or modalities templates when the 'prevent conditions' are met. Prevent Billing grid highlighted on the Codes panel Alert warning of payer-specific coding restrictions Prevent – This selection prevents billing of a code that is not reimbursed by a payer or financial category, or it can be used for when a payer does not allow the specified code to be billed in conjunction with another code on the same encounter. Allow – This selection indicates an exception for a payer that allows billing on a code for which other payers in that financial category do not. Use it only if there is a Prevent selection for the financial category to that this payer belongs to. Alert Only – Select this option to set an alert for a designated code that a user sees when documenting on the treatme

NextGen® Therapy Suite Help 30.3.13.0

Modifiers

In the Modifiers grid, you can specify codes or code combinations that require a modifier to be attached to the selected code. In the example below, if (97110) is documented, then the 59 modifier must be attached to the PT Re-Evaluation code (97164). Modifiers grid Add a Modifier Parent topic: Payer Specific Billing Panel

NextGen® Therapy Suite Help 30.3.13.0

Configure Payer-Specific Adjustments

Set up a payer that allows less than 8 minutes in order to bill a unit. Note: You must apply adjustments to each code for which they apply. Select a code in the CPT Codes grid (in the CPT Codes panel), that you want to apply the override to. This pulls that code into the fields above the grids in the Payer Specific Billing panel. Select the Finclass Name field under the Payer Specific Adjustments grid. This opens a picklist of all financial classes that have been configured for your organization. Select the financial class, and then select OK. Select the Payer Name field and select a payer name from the list. Enter in the Time Rule amount. Enter the new minimum time that the payer allows. If the payer has a maximum number of allowable units that differs from the standard, enter that in the Max Units field. Payer Specific Adjustments grid If Medicare is the secondary insurance, select the MC Rule checkbox. The system uses the payer-specific adjustments (minimum minutes) and then applies

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

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® Medication Inventory Control Help 10.6.3.0

Update Any Billing Rule

You can update any billing rule. The steps are the same for both standard and special billing rules. Note: For the default all-payer rules, you cannot update the Financial Class or Payer name (these must remain as asterisks), but you can change the Quantity-to-Billing Unit ratio. In the Medication Information Configuration grid, select the medication for which you want to update the rule. Select the entry in the Billing Rules grid. The fields below the grid fill in. Change the field entries as needed. Select Update to save the changes to the grid. Parent topic: Configuring Billing Rules

Payer Specific Adjustments Grid

Recommendations

Prevent Billing Grid

Modifiers

Configure Payer-Specific Adjustments

Payer Specific Billing Panel

Add a Billing Limitation

Update Any Billing Rule

Prevent Billing Grid

Modifiers

Configure Payer-Specific Adjustments

Payer Specific Billing Panel

Add a Billing Limitation

Update Any Billing Rule