Add Medical Necessity Certificate

Help Guide for NextGen® Enterprise PM 8

Add Demographics to Patient Profiles

You can add demographics such as the patient's general information, address, contact information, and insurance details. You can also specify if a person is a smoker or veteran on the Demographics tab of Add Person Information window. Additionally you can enroll the patient or person in the Enterprise Chart to view encounters from different practices in NextGen® Enterprise EHR. Note: The optional and mandatory fields that appear on the Add Person Information window can be configured by your system administrator in Enterprise Preferences in File Maintenance. The mandatory fields appear in red color. Open NextGen® Enterprise PM. On the main toolbar select Lookup or People Lookup The Person Lookup window opens. Select New. The Add Person Information window opens. Add Person Information window Add the optional and mandatory information for the following in the Demographics section of the Add Person Information window. Address Demographics Contact Information Insurance Listing Select OK. Co

Help Guide for NextGen® Enterprise PM 8

Adding Person or Patient Details

To add a patient, you must first enter data for all mandatory fields of the complete the required fields on each tab of the Add Patient Information or Add Person Information window, and then for other fields required by your practice. A system administrator can configure the mandatory fields in Enterprise Preferences and Practice Preferences in File Maintenance. The Add Patient Information or Add Person Information window contains the following tabs: Demographics UDS Status - complete the practice and enterprise required fields Client Defined Provider Relations/Role Ext Pharmacy Chart Details After you enter data in the mandatory fields, you can save the information. Adding Information to Person or Patient Profiles You can enter the general, contact, demographic and insurance information for persons or patients on the Demographics tab. Add Demographics to Patient Profiles You can add a patient's demographic information through the Add Person Information window. Set up Patient Status Yo

Help Guide for NextGen® Enterprise PM 8

Access the CMN Information Window

In the Certificates of Medical Necessity Information window, you can enter the CMN information for a patient encounter insurance. Certificates of Medical Necessity Information window can be accessed from the following areas in NextGen® Enterprise PM. Patient Chart > Encounters tab Charge Posting window To open the Certificates of Medical Necessity Information window from the Patient Chart > Encounters tab, do the following: Open NextGen® Enterprise PM. Select Chart. The Patient Lookup window opens. Select the desired patient, and then select Open. The Patient Chart opens for the desired patient. Select the Encounters tab, and then select the desired encounter from the Encounters list. Select the Insurance sub-tab. In the Encounter Insurance section, highlight the insurance that requires the CMN information and do one of the following: Right-click on the insurance and select CMN from the menu. Select Open Record in the Verification section, and then select Open Record in the Certificate

Help Guide for NextGen® Enterprise PM 8

Certificate of Medical Necessity

In File Maintenance, you can create Certificate of Medical Necessity (CMN) forms for Durable Medical Equipment (DME) devices by SIM code. Each form includes specific questions and answer formats that are required by payers for a specific DME device. When you create the CMN form, it is used in NextGen® Enterprise PM to enter information and answer questions related to a patient’s DME device. This information is then included in the electronic 837P (1500) claim file for payers that require CMN information for that specific CPT4 code. Note: The CMN Information is not related to the Medical Necessity functionality in NextGen® Enterprise PM that evaluates CPT4 and ICD codes to determine whether the procedure is medically necessary. Access the CMN Information Window You can enter the CMN information for a patient's encounter insurance from the Certificates of Medical Necessity Information window. Add or Modify CMN Information for an Encounter Insurance You can add or modify the CMN informati

NextGen® Enterprise EHR Help

Checking Medical Necessity for a Test

To determine if Medicare or another insurance (which follows Medicare guidelines) covers the cost of a test, you can run the NextGen® Medical Necessity Check. You can set up the Medical Necessity Check in File Maintenance to run automatically when you save an order or you can run it manually. Note: To use the NextGen® Medical Necessity Check when selecting tests, you must first set it up in File Maintenance. For more information about setting up Medical Necessity, go to the NextGen Healthcare Success Community and download the Orders Module Setup Guide for NextGen® Enterprise. To run it manually, select the Check Medical Necessity in the Assign Diagnosis to Selected Tests panel. Obtain the ABN Report and Verify Cost Coverage When a NextGen Medical Necessity Check Fail Parent topic: Assign Diagnosis to Selected Tests Panel

NextGen® Enterprise EHR Help

Medical Necessity Setup

You must set up the NextGen® Medical Necessity Check to determine if Medicare will pay for a test when selecting a diagnosis for an order and run it when you place a test order. If Medicare or other insurance does not cover the costs of the test, you can print an Advanced Beneficiary Notice (ABN) and record the patients' decision about how to handle test codes. If an order does not contain Medicare or other insurance then you can't run NextGen® Medical Necessity Check as this follows the Medicare guidelines. Note: You need to obtain a license to run NextGen® Medical Necessity Check. To set up the NextGen® Medical Necessity Check locations, do the following: Access and download the NextGen® Medical Necessity Check update package from the NextGen Healthcare Success Community. This package populates the Locations (and associated data) in the Orders Module tab. Set up the appropriate NextGen® Medical Necessity Check encounter level insurance for the appropriate location. For more informati

Add Medical Necessity Certificate

Recommendations

Add Demographics to Patient Profiles

Adding Person or Patient Details

Access the CMN Information Window

Certificate of Medical Necessity

Checking Medical Necessity for a Test

Medical Necessity Setup

Add Demographics to Patient Profiles

Adding Person or Patient Details

Access the CMN Information Window

Certificate of Medical Necessity

Checking Medical Necessity for a Test

Medical Necessity Setup