Add or Modify Revenue Codes 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

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

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 Revenue Codes for Encounter Rate Billing

Encounter rate payers that are billed on UB/837I claims require a four-digit revenue code in Field Locator 42 for each line item on the claim. Therefore, a revenue code must be attached to all SIM codes in the Service Items library that may be billed on a UB/837I claim. Note: The Revenue Codes master file in File Maintenance is pre-installed. Items should be reviewed and modified as needed. To add or modify a revenue code for encounter rate billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Revenue Codes. The Revenue Codes List window opens. Do one of the following: To add a revenue code, select Open Menu and select New. To modify a revenue code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Revenue Code Information window opens. In the Code field, enter the four-digit revenue code. This field is required. In the Description field, enter a descriptive name for the revenue code. This field is requi

Help Guide for NextGen® Enterprise PM 8

Set Up Revenue Codes for Roll-Up Billing

Roll-up payers that are billed on UB/837I claims require a four-digit Revenue Code in Field Locator 42 for each line item on the claim. Therefore, a Revenue Code must be attached to all SIM codes in the Service Items Library that may be billed on a UB/837I claim. Note: The Revenue Codes master file in File Maintenance is pre-installed. Items should be reviewed and modified as needed. To set up a revenue code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Revenue Codes. The Revenue Codes List window opens. Do one of the following: To add a revenue code, select Open Menu and select New. To modify a revenue code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Revenue Code Informationwindow opens. In the Code field, enter the four-digit revenue code. This field is required. In the Description field, enter a descriptive name for the revenue code. This field is required. The Occurrence Co

Help Guide for NextGen® Enterprise PM 8

Set Up Revenue Codes for Roll-Up Billing

Roll-up payers that are billed on UB/837I claims require a four-digit Revenue Code in Field Locator 42 for each line item on the claim. Therefore, a Revenue Code must be attached to all SIM codes in the Service Items Library that may be billed on a UB/837I claim. Note: The Revenue Codes master file in File Maintenance is pre-installed. Items should be reviewed and modified as needed. To set up a revenue code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Revenue Codes. The Revenue Codes List window opens. Do one of the following: To add a revenue code, select Open Menu and select New. To modify a revenue code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Revenue Code Informationwindow opens. Add Revenue Code Information In the Code field, enter the four-digit revenue code. This field is required. In the Description field, enter a descriptive name for the revenue code. This field i

Add or Modify Revenue Codes for Encounter Rate Billing

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