Create a GPCI (Geographic Practice Cost Index) Library

File Maintenance Help for NextGen® Enterprise 8

Create a GPCI Library

In File Maintenance, select Libraries > GPCI. The GPCI Library Maintenance window opens. Do one of the following: To add a new item, select open menu button , and then select New. To modify an existing item, select the item in the list, select open menu button , and then Open. You can also double-click to open the item. The GPCI Library Maintenance window opens. Enter a library name. You can enter information in the columns or Import a GPCI Comma Delimited Flat File. Carrier/Locality – The 91 areas defined by CMS. Carrier/Locality Description – The description of the 91 areas defined by CMS. GPCI Work – Physician work, which is based on the earnings of professionals (lawyers, engineers, and others) reported in the decennial census (done every 10 years). GPCI PE – Practice Expense (PE), which is based on geographic differences in non-physician staff wages, office space costs, and equipment and supplies. GPCI PLI – Professional Liability Insurance (PLI), which is based on data CMS period

File Maintenance Help for NextGen® Enterprise

Import a GPCI Comma Delimited Flat File

Before you begin Ensure the comma-delimited flat file meets the following criteria: Carrier and locality must be merged into one column. For example, New Orleans, LA has a Carrier of 528 and Locality of 01. Merge the columns to read 52801. The columns must be in the following order: Carrier/Locality, Description, GPCI Work, GPCI PE, and GPCI PLI. Remove column headings. Remove commas between state and city. Open File Maintenance and select Libraries > GPCI to open the GPCI Library List. Select the library to import the values into. Note: If the library already contains GCPI values, the newly imported values are appended to the existing ones. However, if an imported carrier or locality is the same as an existing one but its values are different, then the values are replaced with the imported ones. Select the open menu button and then select GPCI Import. The Import GPCI Values window opens. Select the open folder icon to locate the open the flat file, and then select OK. The values are i

File Maintenance Help for NextGen® Enterprise 8

GPCI Codes Library

You can use Geographic Practice Cost Index (GPCI) codes to adjust payment rates to account for differences in the price of doing business in different localities. GPCIs are locality-specific – there are 91 areas in the United States, and 34 of the areas are statewide. The RVU for a component is multiplied by the GPCI value for the same component to calculate the adjusted fee schedule payment amount for a specific locality. The three GPCI components are based on geographic location and are: Work component Practice Expense component Practice Liability (malpractice) component The adjusted fee calculations are: Non-Facility Fee Payment Formula: [(Work RVU x Work GPCI) + (Non-Facility RVU x PE GPCI) + (Malpractice RVU x PLI GPCI)] x Conversion Factor Facility Fee Payment Formula: [(Work RVU x Work GPCI) + (Facility RVU x PE GPCI) + (Malpractice RVU x PLI GPCI)] x Conversion Factor The codes in the GPCI Library are used in the: Contracts Library for the Contract Global Update to calculate ne

File Maintenance Help for NextGen® Enterprise 8

Import a GPCI Comma Delimited Flat File

You can import a comma delimited flat file to add GPCI values to an existing GPCI library. Make sure your comma delimited flat file meets the following criteria: Carrier and Locality must be merged into one column. For example, New Orleans, LA has a Carrier of 528 and Locality of 01. The two values would be combined in one column to become 52801. There are five columns and the data in each row must be in the following order: Carrier/Locality, Description, GPCI Work, GPCI PE, and GPCI PLI. Commas must be removed. For example, NEW ORLEANS, LA would become NEW ORLEANS LA. The column headings must be removed. Select Libraries > GPCI to open the GPCI Library List. Select the name of the library to import the values into. Note: If the library already contains GCPI values, new imported values are appended after the existing ones. However, if an imported carrier or locality is the same as an existing one but its value is different, the value is replaced with the imported one. Select open menu

File Maintenance Help for NextGen® Enterprise 8

Globally Update Pricing in a Contract Library

You can globally update the pricing in payer fee schedules in a contract library. This kind of update calculates the allowed and reimbursement amounts by using RVU and GPCI information. To globally update the pricing in a contract library: In File Maintenance, select Libraries > Contracts. Right-click the applicable library, and then select Contract Global Update. The Contract Global Update window opens. Enter a CPT4 code range by typing a CPT4 code in the CPT4 field and another CPT4 code in the Thru CPT4 field, and the effective date of the CPT4 codes in the Effective Date field. To use RVU and GPCI information to calculate the price, do the following: Select the RVU library. Select a GPCI library, if necessary, and then select a carrier or locality. If you want to use the RVU library to calculate the SIM RVU, select an RVU in the RVU field (this list of RVUs comes from the RVU library), and then the GPCI value in the GPCI field. You can select up to three RVUs and GPCIs to use in the

File Maintenance Help for NextGen® Enterprise 8

Providers System Tab

On the System tab, you can add a provider or modify provider details using the following field descriptions. Field Description Provider Payers This field lists payers and payer numbers added to the provider. After you add a provider, you should add values in the Provider Payers list. Taxonomy Code This field displays a default taxonomy code to classify providers according to type or specialty. Specialty Code1/ Specialty Code2 This field displays the provider's specialty codes. You can modify specialties in the Specialties master file. Provider Subgrouping 1/ Provider Subgrouping 2 (User-defined fields) This field displays provider subgrouping category types that you can use as reporting filters. To modify the information, you can refer to the Provider Subgrouping 1 and Provider Subgrouping 2 fields on the General tab of the Enterprise Preferences window. Employer This field displays the provider's employer. The employers listed are maintained in the Employers master file. Primary Locat

Create a GPCI (Geographic Practice Cost Index) Library

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