NextGen Knowledge Center

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering.

These rules determine which provider goes on the claim and includes the following criteria:

  • Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios.
  • If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim.
  • If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim.
  1. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab.

  2. Define Claim Options parameters for the selected valid payer(s):
    • Send surgical as SV item: Select this option to populate the surgical procedure from the Surg Proc field on the Charge Posting window as the service line item on the claim.
    • Send surgical as HI*BP: Select this option to populate the surgical procedure from the Surg Proc field on the Charge Posting window as the 2300 HI*BE on the 5010 837P claim. This option is selected by default.
  3. To save changes and close the window, select OK.
  4. The Disable rendering claim break field determines which provider is selected to go on the claim as the rendering provider.
    • For billing Non-Split Charges, go to Step 5.
    • For billing Split Charges, go to Step 6.
  5. A practice that does not split charges for billing:
    • Always bills under the MDA's credentials.
    • Only sends a single claim for anesthesia services.
    • Only includes the CRNA on a claim when an MDA is not present on the charge.
    You can use the following options for Non-Split Billing:
    • Use Encounter MDA
      Select this option to:
      • Use the MDA from the encounter.
      • If MDA is not present on the encounter, then use the rendering provider from the encounter.
    • Use MDA from the First Anesthesia Charge Line
      Select this option to:
      • Use the MDA from the first anesthesia charge line.
      • If MDA is not present on the first anesthesia charge line, then use the rendering provider from the first charge line.
    • Use the MDA with the Greatest Total Time
      Select this option to:
      • Use the MDA from the charge line with the greatest total time.
      • If MDA is not present on the charge line with the greatest total time, then use the rendering from the charge line.

        When there are two providers with equal total time, the first of those two providers on the encounter is selected for the claim.

  6. You can use the following options for Split Billing:
    • Use Encounter Provider
      Select this option to use:
      • The encounter rendering provider for the CRNA claim.
      • The encounter MDA for the MDA claim.
    • Use Rendering from the First Anesthesia Charge Line
      Select this option to use:
      • The rendering provider from the first anesthesia CRNA charge line (based on CRNA modifier present) for the CRNA claim.
      • The rendering provider from the first MDA anesthesia charge line (based on MDA modifier present) for the MDA claim.
    • Use the Rendering with the Greatest Total Time
      Select this option to use:
      • The rendering provider from the CRNA charge line(s) (based on the CRNA modifier present) with the greatest total time for the CRNA claim
      • Uses rendering provider from the MDA charge line(s) (based on MDA modifier present) with the greatest total time for the MDA claim.

        When there are two providers with equal total time, the first of the two providers on the encounter is selected for the claim.