Set Up SIM Options for Anesthesia Billing
The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments.
- On the Anesthesia Library Payer Maintenance window, select the SIM Options tab.
- Select Open Menu and select New.
The SIM Range window opens.
- In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK.
- Select (highlight) the SIM range and use the following table to define SIM Options parameters for the selected SIM range and Valid Payers.
- To save changes and close the window, select OK.
Field Description Exempt from Concurrency Select this check box to exclude 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 Select this button to enter 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
Select this option when a payer has different minutes per unit rules for a specified time frame. For example, 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, 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
Enter 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 Select this check box to enable contractual adjustments for the selected SIM range. Allowed Unit Price Enter 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 Select 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 Select this check box to exempt the selected SIM range from contract adjustments. Note: If selected, the Contractual Adjustments section becomes disabled.