Activate a Single Unit Revenue Code Roll Up

File Maintenance Help for NextGen® Enterprise 8

Single Unit Revenue Code Roll Up

This is used primarily by CHC (Community Health Clinic) clients. The revenue code takes multiple line items that are flagged and have the same revenue code or alternate revenue code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a Single Unit Revenue Code Roll Up Parent topic: Payer Tab - SIM Library

File Maintenance Help for NextGen® Enterprise 8

Activate a CPT4 Roll Up

Open a Service Item library and then select a SIM. Select the Payer tab. Select the Single Unit CPT4 Roll Up check box. Select this check box if you want the application to roll up charges that are associated with the SIM's CPT4 code and have a quantity of 1 when claim is billed. Parent topic: CPT4 Roll Up

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With this setup, all SIM codes on an encounter with the same revenue code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-u

Help Guide for NextGen® Enterprise PM 8

Set Up Practice Preferences for Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code requires specific settings in the SIM Library. In order to flag SIM codes for roll-up billing, the Enable Qualifying Encounter Billing option must be selected in Practice Preferences. This enables the Single Unit Revenue Code Roll Up check box on the Payer tab in the SIM Library. Note: This setting is also required for tracking qualifying encounters in NextGen® Enterprise PM. It enables the three Qualifying Encounter check boxes on the General tab in the SIM library. To enable Qualifying Encounter Billing for the practice, do the following: Access Practice Preferences. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Practice Preferences Parent topic: Setting Up Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by Revenue Code

To set up a SIM code for roll-up billing by revenue code, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate Revenue Code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional

File Maintenance Help for NextGen® Enterprise 8

CPT4 Roll Up

A CPT4 roll up combines the total charges for SIMs using the same CPT4 code into a single charge. If you enter an alternate CPT4 code for a SIM designated to perform CPT4 roll up, the application combines the charges with the alternate CPT4 code. To combine the total charges from SIMs using different CPT4 codes, each SIM included in the roll up must be mapped to the same alternate CPT4 code. You can perform line item roll-ups in the following instances: The separate line item charges are totaled. The quantity of line item charges are "rolled up" to become a single charge. CPT4 roll up is used primarily by CHC (Community Health Clinic) clients. The CPT roll up takes multiple line items that are flagged and have the same CPT code or alternate CPT code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a CPT4 Roll Up Parent topic: Payer Tab - SIM Library

Activate a Single Unit Revenue Code Roll Up

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