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SIM Options for Anesthesia Billing

SIM Options for Anesthesia Billing

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Field	Description
Exempt from Concurrency	Excludes 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 charges for MDA/CRNA. The SIM does not split during the conversion process and is billed without medical direction modifiers. Note: If selected, the Anesthesia Concurrency Audit report displays the following blue warning message: SIM exempt from concurrency.
Add on codes – split bill claims handling	If blank, default functionality sends add-on charges for the selected SIM range, such as PQRS codes, on MDA claims only. To send add-on charges on MDA and/or CRNA claims for the selected payers, select one of the following options: <none> Send charge on both claims Send charge only on CRNA claims Send charge only on MDA claims
Anesthesia Minutes per Unit:
Minutes per Unit	Enters the number of minutes per unit for the selected SIM range. Maximum setting is 9999. Minutes per Unit may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Minutes per Unit for the charge: Minutes Per Timespan for SIM range on the SIM Options tab of the Anesthesia library Minutes Per Unit for SIM range on the SIM Options tab of the Anesthesia library Minutes Per Unit on the Concurrency Rules tab of the Anesthesia library Anesthesia Minutes per Unit on the Defaults-2 tab of the Payers master file
Minutes per Timespan From/Thru	Refers a payer with different minutes per unit rules for a specified time frame. If a payer may permit billing of 4 units per hour for the first hour (1 unit = 15 minutes) but only 1 unit per hour for subsequent hours (1 hour = 60 minutes). Up to three From/Thru ranges can be entered with different Minutes per Unit. The From 1 value defaults to 0 and the Thru 1 value defaults to a maximum of 9999. When a From 2 value is entered, the Thru 1 value updates accordingly and the Thru 2 value defaults to 9999. When a From 3 value is entered, the Thru 2 value updates accordingly and the Thru 3 value defaults to 9999. This eliminates any potential gaps in time. Minutes per Unit may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Minutes per Unit for the charge: Minutes Per Timespan for SIM range on the SIM Options tab of the Anesthesia library Minutes Per Unit for SIM range on the SIM Options tab of the Anesthesia library Minutes Per Unit on the Concurrency Rules tab of the Anesthesia library Anesthesia Minutes per Unit on the Defaults-2 tab of the Payers master file
Total Time Units Minimum/Maximum	Enter minimum and maximum unit values for payers that have rules for the selected SIM range defining the minimum and/or maximum number of time units that are allowed to be billed. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the total time units must fall within the minimum/maximum range defined here. If the total time units are less than the defined minimum, the defined minimum is used to calculate the extended price. If the total time units are greater than the defined maximum, the defined maximum is used to calculate the extended price. Base Units + Time Units + Modifier Units = Total Anesthesia Units
Anesthesia SIM Price
Flat Rate	If the price for the selected SIM range should be a flat rate amount, regardless of the total number of units, you can select the Flat Rate option in the drop-down field and enter the dollar amount in the field to the right. Note: When an anesthesia charge is entered, Flat Rate is the first step in the hierarchy used in determining the price.
Override Unit Price	If the unit price for the selected SIM range should be different from the unit price defined in other areas, select the Override Unit Price option in the drop-down field and enter the unit price in the field to the right. 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 Unit Price may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Unit Price for the charge: Minutes Per Timespan for SIM range on the SIM Options tab of the Anesthesia library Default Unit Price on the Concurrency Rules tab of the Anesthesia library Service Items Library > SIM Exceptions > Non-Facility/Facility Amount Non-Facility/Facility Price on the General tab of the Service Items library Note: If the user manually enters an Override price during charge posting, it is used for the total charge amount regardless of the unit price derived from the above hierarchy.
Total Price Minimum/Maximum	Enters minimum and maximum dollar amounts for payers that have rules for the selected SIM range defining the minimum and/or maximum price that is allowed to be billed. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the total calculated price for all anesthesia charges on the encounter must fall within the minimum/maximum price. If the total calculated price for the encounter is less than the defined minimum price, the defined minimum price is used as the extended price for the SIM and distributed across charge lines with weighted distribution based on price. If the total calculated price for the encounter is greater than the defined maximum price, the defined maximum price is used as the extended price for the SIM and distributed across charge lines with weighted distribution based on price. Note: These fields are not available if Flat Rate was selected in the Anesthesia SIM Price field.
Contractual Adjustments	Enables contractual adjustments for the selected SIM range.
Allowed Unit Price	Enters the contractual allowed unit price for the selected SIM range for the selected payers. Note: This overrides the Contract Allowed Unit Price defined for all anesthesia SIMs on the Concurrency Rules tab, if any.
Transaction Code	Selects the third-party adjustment transaction code to be used for contractual adjustments for the selected SIM range. Note: This overrides the Transaction Code selected on the Concurrency Rules tab, if any.
Exempt from Contractual Adjust	Exempts the selected SIM range from contract adjustments. Note: If selected, the Contractual Adjustments section becomes disabled.