Medical Direction Field Descriptions

Field	Description
Concurrency Modifiers
Personally performed by a Physician	Indicates the anesthesiologist performed the case alone.
CRNA performing without medical direction	Indicates the CRNA performed the case alone without medical direction by an anesthesiologist.
Medical Direction of 1 Case
Medical Director	Indicates the anesthesiologist provided medical direction for one CRNA case.
CRNA	Indicates the CRNA performed a case with medical direction by an anesthesiologist.
Medical Direction of 2-4 Cases
Medical Director	Indicates the anesthesiologist provided medical direction for 2-4 CRNA cases. For example, `QK`.
CRNA	Indicates the CRNA performed a case with medical direction by an anesthesiologist.
Medical Direction of 5+ Cases:
Medical Director	Indicates the anesthesiologist provided medical direction for 5 or more CRNA cases.
CRNA	Indicates the CRNA performed a case with medical direction by an anesthesiologist.
Reduced base units	The base units for the Medical Director charge line service is reduced to this value when the maximum number of concurrent encounters is exceeded. The default value is 3. The total anesthesia units for the MDA is equal to the reduced base unit price and the Present at Induction time unit if it is checked in the Anesthesia Services Information window. Time and other modifying units are not included in the MDA claim. CRNA claims are not affected.

File Maintenance Help for NextGen® Enterprise

Set Up Medical Direction for Anesthesia Billing

Setting up medical direction in anesthesia billing ensures proper supervision and compliance with regulatory standards, particularly for Medicare and other insurance billing. You can assign concurrency modifiers and documentation modifiers in the Medical Direction. In NextGen® Enterprise PM, the modifiers assigned to each level of concurrency 1 case, 2-4 cases, and 5+ cases determine whether charges are split between Medical Director and CRNA during the Anesthesia Concurrency Audit process. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. In Anesthesia Library Payer Maintenance, select Medical Direction. In Medical Direction, enter the concurrency modifiers, and medical direction of 1, 2-4, and 5+ cases. Select OK. Medical Direction Field Descriptions You can set up the medical direction for anesthesia billing. Parent topic: Add or Modify an Anesthesia Library

Help Guide for NextGen® Enterprise PM 8

Medical Direction Field Descriptions

In Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases, Charges are split for the level of concurrency when a modifier is assigned to the Medical Director and CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Charges are not split for the level of concurrency when a modifier is either assigned to the Medical Director or CRNA, or when both fields are blank. Field Description Concurrency Modifiers Personally performed by a Physician Indicates the anesthesiologist performed the case alone. CRNA performing without medical direction Indicates the CRNA performed the case alone without medical direction by an anesthesiologist. Medical Direction of 1 Case Medical Director Indicates the anesthesiologist provided medical direction for one CRNA case. CRNA Indicates the CRNA performed a case with medical direction by an anesthesiologist. Medical Direction of 2-4 Cases Medical Director Indicates the ane

File Maintenance Help for NextGen® Enterprise 8

Medical Direction Field Descriptions

In the Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases sections, if a modifier is assigned to either the CRNA or the Medical Director but not both, then split billing does not occur. Split billing occurs when a modifier is assigned to both the Medical Director and the CRNA. Field Description Concurrency Modifiers: Personally performed by a Physician Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, AA. CRNA performing without medical direction Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, QZ. Medical Direction of 1 Case: Medical Director Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, QY. CRNA Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, QX. M

Help Guide for NextGen® Enterprise PM 8

Medical Direction Field Descriptions

In the Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases sections, if a modifier is assigned to either the CRNA or the Medical Director but not both, then split billing does not occur. Split billing occurs when a modifier is assigned to both the Medical Director and the CRNA. Field Description Concurrency Modifiers: Personally performed by a Physician Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, AA. CRNA performing without medical direction Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, QZ. Medical Direction of 1 Case: Medical Director Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, QY. CRNA Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, QX. M

Help Guide for NextGen® Enterprise PM 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

File Maintenance Help for NextGen® Enterprise 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

Medical Direction Field Descriptions

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Set Up Medical Direction for Anesthesia Billing

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Medical Direction Field Descriptions

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Medical Direction Field Descriptions

Medical Direction for Anesthesia Billing

Medical Direction for Anesthesia Billing