The General tab on the Encounter Rate Billing Library Maintenance window contains rules that apply when the ER payer is the primary, secondary, or tertiary payer on the encounter.
- Open the Encounter Rate Billing library.
The
Encounter Rate Billing Library Maintenance window opens.
- On the General tab, set the general billing rule options as needed.
- Set the Encounter Rate Exempt setting. This setting applies only when one or more of the charge line SIM codes is flagged as Enc rate exempt in the Service Items library.
The options are:
- Disqualify patient encounter from ER billing if: Select one of the following options to set the basis for disqualifying an encounter from encounter rate billing:
- All SIMs are ER exempt
- Only one SIM is ER exempt
- Suppress claim for disqualified patient encounter: Select this option to suppress the claim for any encounter that is disqualified from encounter rate billing based on exempt SIM codes.
- Select a Multiple Patient Encounters per day setting. This setting applies only when a patient has more than one encounter on the same day with the same encounter rate payer.
The option is:
- The decision will be made by: Select one of the following options to determine how multiple same day/same payer encounters are selected for billing to the encounter rate payer:
- PM Selection: Select this option to have the system automatically flag the first same day/same payer encounter identified during the billing process as Multi-Yes on the Billing & Collections tab of the Encounter Maintenance window. A claim is created for the Multi Yes encounter. Other same day/same payer encounters for the patient are suppressed from creating claims, if the Suppress claim for multiple same-day encounters option is enabled on the Primary Encounter Rate tab.
- Manual Selection: Select this option to have users determine which same day/same payer encounter should be billed. The user manually flags each encounter as either Multi Yes or Multi No on the Billing & Collections tab of the Encounter Maintenance window. A claim is created for the Multi Yes encounter. Other same day/same payer encounters for the patient flagged as Multi No are suppressed from creating claims, if the Suppress claim for multiple same-day encounters option is enabled on the Primary Encounter Rate tab.
- PM Select All: Select this option to have the system automatically flag all same day/same payer encounters identified during the billing process as Multi Yes on the Billing & Collections tab of the Encounter Maintenance window. A claim will be created for all Multi Yes encounters.
- Set the Alternate Payer setting. This setting applies when the ER payer has CPT4 codes that are billed to an alternate payer.
The option is:
- Do not insert ER SIM for alternate payer claims: Select this option to prevent the ER SIM from appearing on the alternate payer claim. If this option is unchecked, the ER SIM appears on the main payer claim and the alternate payer claim.
- Set the Encounter Rate Insertion setting.
The option is:
- Insert ER SIM into Encounter Maintenance: Select this option to insert and store the ER SIM and value amount on the Billing & Collections tab of the Encounter Maintenance window rather than inserting the ER SIM on the Charge Posting window as a unique service line. This option makes charge based reports more accurate because the ER SIM code is not inserted as an additional charge.
- To save changes and close the window, select OK.
