Use Contract Rates

NextGen® Therapy Suite Help 30.3.13.0

Allow Therapists to Correct a Provider Mismatch

The system now helps with identifying and correcting rendering provider mismatches. If the therapist on the Fee Sheet does not match the rendering or supervising provider on the encounter, you can configure the system to notify the therapist of the issue and allow them to override the rendering provider on the encounter with the therapist or provider submitting charges. In the NTS Practice Config template, scroll to the Fee Sheet section. For the Rendering Provider Mismatch Override setting, select the visit set that the override applies to, and then select one of the following: Automatic makes the You are not the Rendering Provider on this encounter message and the Make me the Rendering Provider checkbox appear on the Fee Sheet. The checkbox is selected by default. When the therapist submits charges, the system automatically updates the encounter rendering provider to be the current user. Manual makes the message and checkbox appear on the Fee Sheet, but the provider must select the c

NextGen® Therapy Suite Help 30.3.13.0

Fee Sheet

Fee Sheet section of the Practice Config template Use Contract Rates Display Medicare Rule Track KX Modifier in EPM Configure Time Based Alert for Eval and Re-Eval Visits You can configure the alert to notify the therapists that they have not documented enough time for the evaluation or re-evaluation portion of the visit as per the practice standards. Allow Therapists to Correct a Provider Mismatch Set up whether therapists can correct the rendering provider mismatch before they submit charges from the Fee Sheet. Parent topic: Practice Configuration

NextGen® Therapy Suite Help 30.3.13.0

Payer Reimbursement & Medicare Therapy Cap

The payer reimbursement rate is used to calculate the Medicare Cap usage and to determine optimal billing when payers have a billing cap configured in the Financial Class Setup panel. For example, if a payer has a 4-unit cap, this may result in the need to throw out a code. So, the system looks at the configured reimbursement rates to determine optimal billing. If you are using contracts in File Maintenance and have them turned on on the NTS Practice Config practice template, the system looks to those for the reimbursement rates. If you are not using contracts in File Maintenance, you must assign payer reimbursement rates so that in the event of a tie, and to prevent under-billing, the system can determine which code to send. All reimbursement rates are assigned to Financial Classes. You must indicate the reimbursement rates for all Financial Classes within the Financial Categories that have been assigned specific billing limitation in the NTS Billing Config template. Assign Reimbursem

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

File Maintenance Help for NextGen® Enterprise 8

Set Up Auto Charge Adjustments for Non-Participating Providers

Before you begin For the Contract's auto-charge adjustment to work properly, you must populate the following fields on the General tab of the Contract Library Maintenance window: Add a value to the % of Allowed Amount for NonParticipants field Select the Automatically adjust charges check box The application enables you to set up auto-adjustments for non-participating providers based on the terms of their contract. When charges are entered, they are adjusted according to the terms of the contract for the non-participating providers. In File Maintenance, access the Payers Master File. The Payer List window appears. Select the open menu button and select New to set up a new payer or select Open to modify an existing payer. The Add/Modify Payer Information window appears. Select the Practice tab and then select the Libraries tab. Select the drop-down arrow in the Managed Care Contract field and select the contract that meets the contract terms of the payer. When you select a contract, the

Help Guide for NextGen® Enterprise PM 8

Set Up a Fee Schedule for Contract Payers

The Fee Schedule tab enables you to indicate the amount that you expect to be reimbursed for specific procedures that fall outside of the contract defaults. For example, the co-pay for a CPT4 code might be different from the default co-pay. The options on the Fee Schedule tab override the options on the General tab. The information entered applies when the payer attached to the contract is the primary payer for an encounter. Contractual requirements alerts can be set up to display during appointment scheduling, patient registration, and billing processes. Automatic contractual adjustments and the distribution of insurance reimbursement can be set up to be applied to patient balances. In File Maintenance, select Libraries, and then Contract. The Contracts List window opens. Double-click the applicable library, and then select the Fee Schedule tab. Enter a CPT4 Code. The CPT4 codes and their descriptions that are specific to each contract display in the CPT4/Desc list box. To search for

Use Contract Rates

Recommendations

Allow Therapists to Correct a Provider Mismatch

Fee Sheet

Payer Reimbursement & Medicare Therapy Cap

Assign Reimbursement Rates

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up a Fee Schedule for Contract Payers

Allow Therapists to Correct a Provider Mismatch

Fee Sheet

Payer Reimbursement & Medicare Therapy Cap

Assign Reimbursement Rates

Set Up Auto Charge Adjustments for Non-Participating Providers

Set Up a Fee Schedule for Contract Payers