Add or Modify Departments for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Add or Modify SIM Codes for Encounter Rate Billing

In the Service Items library, you must create an Encounter Rate SIM code for each Encounter Rate CPT4 code. To add or modify a SIM code for encounter rate billing, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add an Encounter Rate SIM code, select Open Menu and select New. To modify an Encounter Rate SIM code, search for the code and then select the code from the list on the left. Service Item Library Maintenance In the CPT4 Code field, enter the encounter rate CPT4 code and then press Tab. In the two Modifier fields, press Tab to leave the fields blank. The Service Item # field automatically defaults to the encounter rate CPT4 code. Press Tab. The Description field automatically defaults to the description for the encounter rate CPT4 code. Press Tab. On the

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Add or Modify Transaction Codes for Encounter Rate Billing

Transaction codes can be used in the Encounter Rate Billing library to auto-adjust charges for payers using encounter rate billing. Having unique transaction codes assists in differentiating encounter rate adjustments from other types of adjustments on the UDS report. It also assists in either including or excluding encounter rate adjustments on financial reports in NextGen® Enterprise PM. If encounter rate billing is used for more than one payer, create a separate transaction code for each payer. For example: Medicare Enc Rate Adjustment Medicaid Enc Rate Adjustment To add or modify a transaction code for encounter rate billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Transaction Codes. The Transaction Codes List window opens. Do one of the following: To add a transaction code, select Open Menu and select New. To modify a transaction code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Transacti

Help Guide for NextGen® Enterprise PM 8

Add or Modify CPT4 Codes for Encounter Rate Billing

Encounter rate billing involves the insertion of an Encounter Rate (ER) code onto the patient's encounter. The ER code can then be included on the claim to the payer. The ER code must first be created as a CPT4 code. Example ER Codes may include the following: Medicare FQHC: G0466, G0467, G0468, G0469, G0470 Medicare RHC: 0521 Clinic Service Medicaid: 0529 Clinic Service Medicaid Texas: T1015 Clinic Service Medi-Cal: 01 Primary, 02 Secondary, 03 Dental, 04 Optometry To add or modify a CPT4 code for encounter rate billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. Add CPT4 Code Information In the Code field, enter the CPT4 code. This field is requ

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Edits for Encounter Rate Billing

When an encounter is billed in NextGen® Enterprise PM, auto-adjustments are applied to the original charges based on parameters defined in the Encounter Rate Billing library. For most Medicaid (non-Medi-Cal) payers, the first charge on the encounter is auto-adjusted to a balance equal to Medicaid's encounter rate, and all other charges are auto-adjusted to a balance of $0.00. All charges, including the $0.00 balance charges, must appear on the claim for Medicaid. To accomplish this, claim edit #97 must be deactivated in the Claim Edits library used for Medicaid. Note: A default Medicaid Claim Edits library comes pre-installed. It is suggested that Claim Edit #97 be deactivated in this library, and then attach the library to Medicaid (non-Medi-Cal) payers. Access File Maintenance. Select Libraries, and then Claim Edits. The Claim Edits List window opens. From the list, select a library and then select Open Menu and select Open. The Claim Edit Library Maintenance window opens. Select the

Help Guide for NextGen® Enterprise PM 8

Add or Modify Departments for Encounter Rate Billing

Creating unique encounter rate departments for use in the SIM library with Encounter Rate (ER) SIM codes can assist with reporting in NextGen® Enterprise PM. Financial reports can be filtered to either include or exclude ER codes by department, and reports can be sorted by department to group ER codes together. If encounter rate billing is used for more than one payer, create a separate department for each payer’s encounter rate SIM code(s). For example: Medicare Enc Rate Medicaid Enc Rate To add or modify a department for encounter rate billing, do the following: Access File Maintenance. Select Master Lists. The Master Lists List window opens. In the Master List field, select Departments. The Departments List appears. Do one of the following: To add a department, select Open Menu and select New. To modify a department, select the department from the list, and then select Open Menu and select Open. The Add/Modify Department Information window opens. Add Department Information In the De

Add or Modify Departments for Encounter Rate Billing

Recommendations

Add or Modify SIM Codes for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Add or Modify Transaction Codes for Encounter Rate Billing

Add or Modify CPT4 Codes for Encounter Rate Billing

Set Up Claim Edits for Encounter Rate Billing

Add or Modify Departments for Encounter Rate Billing

Add or Modify Departments for Encounter Rate Billing

Add or Modify SIM Codes for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Add or Modify Transaction Codes for Encounter Rate Billing

Add or Modify CPT4 Codes for Encounter Rate Billing

Set Up Claim Edits for Encounter Rate Billing

Add or Modify Departments for Encounter Rate Billing