GPCI Codes 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 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

Delete GPCIs from a GPCI Library

To delete GPCI values, do one of the following: To delete all GPCI values: Open a GCPI library. Select open menu button , and then select Delete. All the columns clear. To delete specific GPCI values: Open a GCPI library. In the Filter Criteria field, enter the numbers of the carrier or locality you want to delete. As you enter, the list displays only the matching records. Continue typing until the list contains only the values you want to delete. When the list contains the values you want to delete, select open menu button , and then select Delete. Parent topic: GPCI Codes Library

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

Globally Update Pricing in a SIM Library

You can globally update the pricing of service items in a SIM library. You can filter these SIMs based on a SIM or CPT4 code range, effective date, and department. The global update enables you to change the SIM pricing based on a percentage, a specific dollar amount, or a geographically-adjusted RVU. The adjustments can be rounded up or down. In File Maintenance, select Libraries > Service Items. Right-click the applicable library, and then select SIM Global Update . The SIM Global Update window opens. You must enter an Effective Date to determine which SIMs are updated. SIMs are updated only if this date falls between the SIM effective and expiration dates. To further specify which SIMs are updated, you can apply additional filters by: By doing one of the following: Enter a range of SIM codes to update the SIM codes within this range. Enter a range of CPT4 codes to filter for CPT4 codes in this range. Select a department to filter for SIMs associated with it. A department can be used

File Maintenance Help for NextGen® Enterprise 8

RVU Library

Relative Value Units (RVU) are a methodology for defining payment allowances for physicians. The units are an index that measures the relative amount of resource costs (work, professional, liability, and practice expense) that go into providing each service offered by a physician. You can: Create RVUs Import RVUs Rename RVU Labels in the RVU Library Notes: If you created RVU values in a version of File Maintenance before version 5.5, the RVU values that were created in the CPT4 Code master file are saved in the new RVU library named ''Original CPT4 RVU Values''. The values in the RVU Library are used in the: Reports Contracts Library for the Contract Global Update to calculate new allowed amounts SIM Library for the: RVU Update to calculate new RVU values SIM Global Update to calculate new prices Create Custom RVUs for CPT4 Codes Rename RVU Labels in the RVU Library Import a Medicare RVU Comma Delimited Flat File Delete RVUs from an RVU Library

GPCI Codes Library

Recommendations

Create a GPCI Library

Import a GPCI Comma Delimited Flat File

Delete GPCIs from a GPCI Library

Globally Update Pricing in a Contract Library

Globally Update Pricing in a SIM Library

RVU Library

Create a GPCI Library

Import a GPCI Comma Delimited Flat File

Delete GPCIs from a GPCI Library

Globally Update Pricing in a Contract Library

Globally Update Pricing in a SIM Library

RVU Library