Billing Anesthesia Encounters

Help Guide for NextGen® Enterprise PM 8

Disable Rendering Claim Breaks

Disable Rendering Claim Breaks is used in relief and discontinuous time scenarios to determine which rendering or MD Anesthesia goes on the claim as the rendering provider. When there is more than one anesthesia service line. Claims are created by the rules set in File Maintenance > Libraries > Anesthesia > Anesthesia Library Payer Maintenance > Claim Options tab. If you do not select any options on this window, then claims are created using existing claim splitting rules. The following options are available for selection to identify the rendering provider or MDA to go on the claim when there is more than one anesthesia service line: Option Description Use Encounter MDA (intended for non-split billing) Uses the Encounter MDA Anesthesia for non-split billing, if there is no MDA then it uses the Encounter Rendering. Use Encounter Rendering (intended for split billing) Uses the Encounter MDA on the MDA claim and Encounter Rendering on the CRNA claim. Use MDA from First Anesthesia Charge L

Help Guide for NextGen® Enterprise PM 8

In Progress Billing

When the anesthesia encounter passes the Anesthesia Concurrency Audit they are converted to the unbilled status. Anesthesia functionality changes the In Progress Encounter status for the following reasons: Prevents an encounter from billing until it has passed the Concurrency Audit. Remove the process dates until the Claims Modifier Library has updated the units and modifiers in Charge Entry. Demand mode billing for in-progress encounters is disabled for Practices that have created an Anesthesia Library. Parent topic: Billing Anesthesia Encounters

Help Guide for NextGen® Enterprise PM 8

The Billing Process

The billing process in NextGen® Enterprise PM takes encounters that are in Unbilled or Rebill status and runs those encounters through a claim edits process. Any encounter that passes the claim edits gets a pending claim created that can be printed or exported and then submitted to insurance for payment. You can run the billing process for an individual encounter on demand, or for multiple encounters in a batch. Billing an Individual Encounter You can bill an individual encounter. Bill Multiple Encounters (Batch Billing) You can bill multiple encounters on the Encounter Lookup window. Billing In Progress Encounters You can bill In Progress encounters after converting an In Progress encounter to an Unbilled encounter. Billing Anesthesia Encounters You can bill anesthesia encounters in File Maintenance. Recurring Rental Billing You can enable Recurring Rental Billing in NextGen® Enterprise PM. Parent topic: Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering. These rules determine which provider goes on the claim and includes the following criteria: Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios. If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim. If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab. Define Claim Options parameters for the selected valid payer(s): Send surgical as SV item: Select t

File Maintenance Help for NextGen® Enterprise 8

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering. These rules determine which provider goes on the claim and includes the following criteria: Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios. If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim. If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab. Define Claim Options parameters for the selected valid payer(s): Send surgical as SV item: Select t

Help Guide for NextGen® Enterprise PM 8

Anesthesia Billing

In Progress Billing is required for Anesthesia Concurrency Billing. Encounters with anesthesia charges must be held as In Progress until an Anesthesia Concurrency Audit process is run to check for potential time overlaps. This prevents those encounters from going through the billing process and creating claims until after the audit is performed. CAUTION: Once In Progress Billing has been enabled, it cannot be disabled. It should only be enabled when needed. In Progress Billing is not required for Basic Anesthesia Billing but is required for Anesthesia Concurreny Billing. Parent topic: In Progress Billing Status

Billing Anesthesia Encounters

Recommendations

Disable Rendering Claim Breaks

In Progress Billing

The Billing Process

Set Up Claim Options for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Anesthesia Billing

Disable Rendering Claim Breaks

In Progress Billing

The Billing Process

Set Up Claim Options for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Anesthesia Billing