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.
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 General tab, use the following list to define the remaining parameters for the Encounter Rate SIM code.
Place Of Service: Select Office.
Component : Select Professional.
Department: Select the Department for the ER SIM code. (e.g. Medicare Enc Rate)
Revenue Code: Select the appropriate four-digit Revenue Code for UB/837I claims.
Form: Select 1500 (default). This setting is for most payers.
Note: For encounter rate payers that are billed on UB/837I claims, the UB setup is done in the Payers master file.
Eff Date: Enter the Effective Date for the ER SIM code's Non-Facility Price and Facility Price.
Exp Date: Enter the Expiration Date for the ER SIM code's Non-Facility Price and Facility Price.
Non-Facility Price and Facility Price: Enter $0.00 in both price fields. The amount defined for the ER SIM code in the Encounter Rate Billing library is used instead.
Self pay Qualifying Encounter: Select this check box. It defines the ER SIM code as a Health Center qualifying encounter for patients with no insurance.
Sliding Fee Qualifying Encounter: Select this check box. It defines the ER SIM code as a Health Center qualifying encounter for patients on a sliding fee schedule.
Qualifying Encounters for all payers: Select this check box. It defines the ER SIM code as a Health Center qualifying encounter for patients with insurance.
Send $0 charge on claim: Select this check box to allow the zero dollar ER SIM code to display on claims.
