Payer Specific Billing Panel

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

Financial Class Setup

The Financial Class Setup panel has two grids: one to set up financial classes, and the other to configure billing limitations based on financial categories and payers. Financial Class Setup panel Financial Class Grid Billing Limitations Grid Parent topic: Billing Configuration

NextGen® Therapy Suite Help 30.3.13.0

Visit Type Setup Panel

Use the Visit Type Setup panel to set up and manage Visit Types and their associated billable codes. Visit Type Setup panel Hide Visit Types Enter a New Visit Type Update Visit Types Re-Order Visit Types Visit Types with More Than One Code Parent topic: Billing Configuration

NextGen® Therapy Suite Help 30.3.13.0

Payer Specific Adjustments Grid

Some payers do not follow standard coding guidelines regarding the 8-minute rule. For example, a payer may allow a unit to be billed after five minutes of treatment. To accommodate this, use the Payer Specific Adjustments grid to override the 8-minute minimum for a whole financial class or for just a single payer within a financial class. Configure Payer-Specific Adjustments Parent topic: Payer Specific Billing Panel

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

Payer Specific Billing Panel

Recommendations

Configuring Billing Codes

Financial Class Setup

Visit Type Setup Panel

Payer Specific Adjustments Grid

Prevent Billing Grid

Modifiers

Configuring Billing Codes

Financial Class Setup

Visit Type Setup Panel

Payer Specific Adjustments Grid

Prevent Billing Grid

Modifiers