Import a GPCI Comma Delimited Flat File

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

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

GPCI Codes Library

You can use Geographic Practice Cost Index (GPCI) codes to adjust payment rates to account for differences in the price of doing business in different localities. GPCIs are locality-specific – there are 91 areas in the United States, and 34 of the areas are statewide. The RVU for a component is multiplied by the GPCI value for the same component to calculate the adjusted fee schedule payment amount for a specific locality. The three GPCI components are based on geographic location and are: Work component Practice Expense component Practice Liability (malpractice) component The adjusted fee calculations are: Non-Facility Fee Payment Formula: [(Work RVU x Work GPCI) + (Non-Facility RVU x PE GPCI) + (Malpractice RVU x PLI GPCI)] x Conversion Factor Facility Fee Payment Formula: [(Work RVU x Work GPCI) + (Facility RVU x PE GPCI) + (Malpractice RVU x PLI GPCI)] x Conversion Factor The codes in the GPCI Library are used in the: Contracts Library for the Contract Global Update to calculate ne

File Maintenance Help for NextGen® Enterprise 8

Import a Medicare RVU Comma Delimited Flat File

You can import an RVU comma delimited flat file to add RVU values to the CPT4 codes specified in the RVU flat file. For a successful import, the CPT4 code used in the flat file must exist in the CPT4 master file. Select Libraries > RVU to open the RVU Library List. Select the name of the library to import the values into. Note: If the library already contains RVU values, new imported values are appended to the existing ones. However, if an imported RVU is the same as an existing one but its value is different, the value is replaced with the imported one. Select open menu button , then select RVU Import. The Import RVU Scales window opens. In theComma Delimited Input Filefield, selectOpen Folderto browse for the flat file. TheSelect Filewindow opens. Locate and select the applicable flat file, and then selectOpen. The path for the file location displays in theComma Delimited Input Filefield. Select OK. To see the imported values, open the RVU library and locate the CPT4 code. The values

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

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

Import a GPCI Comma Delimited Flat File

Recommendations

Delete GPCIs from a GPCI Library

Create a GPCI Library

GPCI Codes Library

Import a Medicare RVU Comma Delimited Flat File

Globally Update Pricing in a SIM Library

Globally Update Pricing in a Contract Library

Delete GPCIs from a GPCI Library

Create a GPCI Library

GPCI Codes Library

Import a Medicare RVU Comma Delimited Flat File

Globally Update Pricing in a SIM Library

Globally Update Pricing in a Contract Library