Set Up Concurrency Rules for Anesthesia Billing

File Maintenance Help for NextGen® Enterprise

Set Up Concurrency and Claim Rules for Anesthesia Billing

The Concurrency and Claim Rules section of the Anesthesia Library Maintenance window enables you to define rules for the payers and self-pay. Each set of rules is defined with an effective and expiration date. The date of service and payer on an anesthesia charge determines which set of rules is applied during the anesthesia concurrency audit and billing processes in NextGen Enterprise PM. Open File Maintenance. Select Libraries, and then select Anesthesia. The Anesthesia Library List window opens. From the list, double-click to open the library. The Anesthesia Library Maintenance window opens. In Concurrency and Claim Rules, do one of the following: To create a new rule or row, select open menu , and then select New. To modify an existing rule or row, select open menu , and then select Open. The Anesthesia Library Payer Maintenance window opens. In Effective Date, enter the date the rule set becomes effective. In Expiration Date, enter the date the rule set expires. In Description, en

Help Guide for NextGen® Enterprise PM 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges, the extended price is split across the two resulting charge lines based on the percentages in the Medical Director and CRNA. After the charges are split, units are only used for reporting purposes. Note: The total charge calculation is the same for split billing and non-split billing. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. Select Concurrency Rules. Enter the Concurrency Rules parameters

File Maintenance Help for NextGen® Enterprise 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

Help Guide for NextGen® Enterprise PM 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

File Maintenance Help for NextGen® Enterprise

Add or Modify an Anesthesia Library

Adding and modifying the anesthesia library enables you to modify the codes, rules, templates, and configurations used in anesthesia billing, scheduling, and clinical workflows. The Anesthesia library enables you to define rules that apply to the payers, and self-pay. Each set of rules includes the following: Medical Direction: These rules determine whether modifiers are added to charges based on the level of medical direction and whether charges will be split between Medical Directors and CRNAs. Concurrency Rules: These rules define specific parameters, such as the maximum number of concurrent procedures allowed, whether a Medical Director can perform and direct at the same time, and split-charge percentages for Medical Directors and CRNAs. Claim Options: These rules define specific claim parameters, such as whether or not surgical procedure codes are included on claims, and how claims break by rendering provider. SIM Options: These rules define parameters for specific SIM codes, such

File Maintenance Help for NextGen® Enterprise 8

Set Up SIM Options for Anesthesia Billing

The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments. On the Anesthesia Library Payer Maintenance window, select the SIM Options tab. Select Open Menu and select New. The SIM Range window opens. In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK. Select (highlight) the SIM range and use the following table to define SIM Options parameters for the selected SIM range and Valid Payers. To save changes and close the window, select OK. Field Description Exempt from Concurrency Select this check box to exclude the selected SIM range from being counted against max concurrency (not a concurrent case) for the selected payers. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the SIM is ignored during calculation of concurrent ch

Set Up Concurrency Rules for Anesthesia Billing

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Set Up Concurrency and Claim Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

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Set Up Concurrency and Claim Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Add or Modify an Anesthesia Library

Set Up SIM Options for Anesthesia Billing