Specify a Prevent Billing Event with Alert

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

Add a Security Group Category Payer Alert

Below the Category/Payer Overrides grid, select the fields to select the Category and Payer Name. Under the Rule column, select either Allow or Prevent. Select the action that is allowed or prevented, and then enter the text that you want to appear in the alert. Select Add to add the alert to the grid. Parent topic: Security Group Category/Payer Overrides

NextGen® Therapy Suite Help 30.3.13.0

CPT Code/Payer-Specific Alerts

You can configure payer-specific alerts to show on each of the code grids on Treatment. These alerts: Can be set up to show on any template that billable codes are documented on. Can be used to notify users if a payer has specific rules regarding billing certain CPT codes. Any rule configured shows up in blue text next to the CPT code with a blue information button. The information button opens a window to display the details of the alert. In the following example, Therapeutic activity 97530 is Not Reimbursed for the attached payer. When you select the Info button, the Payer Alert Info opens: Example of a Payer Alert Info message Note: All CPT code alerts are configured in the Billing Config system template in the Prevent Billing grid. Parent topic: Treatment Section

NextGen® Therapy Suite Help 30.3.13.0

Configure a Financial Category Replacement Code

Select the code in the CPT Codes grid (in the CPT Codes panel) that you want to apply a replacement code for. Select the Financial Category field under the Financial Category Replacement Code grid. CPT Codes panel and Payer Specific Billing panel A picklist opens, of all financial categories that have been configured for your organization. Select the financial category, and then select OK. If this replacement only applies to a specific payer within a financial category, select the Payer Name field and select a payer from the list. Otherwise leave this field blank, and the replacement code will apply to all payers within that financial class. If this replacement applies only to a specific visit set, select the Visit Set field, and then select the visit set. Otherwise leave this field blank. Enter the replacement code into the Replacement Cpt Code field. Select Add/Update. The new entry appears in the grid. Parent topic: The Financial Category Replacement Code

NextGen® Orthopedic Suite Help 80.2.14.0

Update an Alert

You can edit or delete an existing alert. On the Billing Configuration practice template, expand the Alerts panel. Select an alert from the grid. The details of selected alert appear in the corresponding fields below the grid. To edit the alert, make changes to the text in the fields as needed, and then click Update. To delete the alert, click Delete. Note: The alert appears based on the primary insurance listed on the encounter. If there is an alert configured for all payers within a financial class (*), this overrides what the individual payer has configured for that chief complaint. Parent topic: Alerts Configuration

NextGen® Therapy Suite Help 30.3.13.0

Set an Alert Override

Select the alert in the Alerts panel grid. Select the Create Override button. Alert Overrides panel with alert information The alert appears the Alert Overrides panel grid. As desired or necessary, do any of the following: If the field under the Message column is not gray, change the text of the message, and then select Update Message. Select a financial class from the list under the Financial Class column. Select a payer from the list under the Payer column. Change or add additional selections for 'When' –templates on which the alert will appear. Select another Visit Set. Select Days or Visits for a frequency. Parent topic: Alert Overrides Panel

Specify a Prevent Billing Event with Alert

Recommendations

Prevent Billing Grid

Add a Security Group Category Payer Alert

CPT Code/Payer-Specific Alerts

Configure a Financial Category Replacement Code

Update an Alert

Set an Alert Override

Prevent Billing Grid

Add a Security Group Category Payer Alert

CPT Code/Payer-Specific Alerts

Configure a Financial Category Replacement Code

Update an Alert

Set an Alert Override