Billing Status for Multiple Same-Day Encounters

Help Guide for NextGen® Enterprise PM 8

Encounter Rate Billing Status

When an encounter is created, the Billing Status field on the Encounter Maintenance window on the Billing & Collections tab in the Encounter Rate sub-tab defaults to Undecided for primary, secondary and tertiary encounter rate billing. Billing Status Once the encounter is billed, the Billing Status automatically changes to indicate the action taken: ER Applied, Exempt, or Non ER Payer. Encounter Maintenance Encounter Rate Billing Statuses include the following: Status Description Undecided Indicates the encounter has not yet been billed. This is the default status used when an encounter is created. ER Applied Indicates the encounter was billed and that encounter rate billing was applied during the billing process. Exempt Indicates the encounter was billed and that encounter rate billing was not applied during the billing process because it was exempt due to the billing rules setup. Multi Yes Used when multiple same day encounters exist for the same encounter rate payer. This status is

Help Guide for NextGen® Enterprise PM 8

Set Up the General Tab

The General tab on the Encounter Rate Billing Library Maintenance window contains rules that apply when the ER payer is the primary, secondary, or tertiary payer on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. On the General tab, set the general billing rule options as needed. Set the Encounter Rate Exempt setting. This setting applies only when one or more of the charge line SIM codes is flagged as Enc rate exempt in the Service Items library. The options are: Disqualify patient encounter from ER billing if: Select one of the following options to set the basis for disqualifying an encounter from encounter rate billing: All SIMs are ER exempt Only one SIM is ER exempt Suppress claim for disqualified patient encounter: Select this option to suppress the claim for any encounter that is disqualified from encounter rate billing based on exempt SIM codes. Select a Multiple Patient Encounters per day setting. This settin

File Maintenance Help for NextGen® Enterprise 8

Set Up the General Tab

The General tab on the Encounter Rate Billing Library Maintenance window contains rules that apply when the ER payer is the primary, secondary, or tertiary payer on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. On the General tab, set the general billing rule options as needed. Set the Encounter Rate Exempt setting. This setting applies only when one or more of the charge line SIM codes is flagged as Enc rate exempt in the Service Items library. The options are: Disqualify patient encounter from ER billing if: Select one of the following options to set the basis for disqualifying an encounter from encounter rate billing: All SIMs are ER exempt Only one SIM is ER exempt Suppress claim for disqualified patient encounter: Select this option to suppress the claim for any encounter that is disqualified from encounter rate billing based on exempt SIM codes. Select a Multiple Patient Encounters per day setting. This settin

Help Guide for NextGen® Enterprise PM 8

Enable Qualifying Encounter Billing

The Encounter Rate Billing functionality in NextGen® Enterprise PM includes logic that identifies multiple encounters for a patient on the same date of service at the same location with the same encounter rate payer. Qualifying Encounter Billing must be enabled for the practice. When enabled, the Encounter Rate Billing Status fields display on the Billing & Collections tab of the Encounter Maintenance window. These fields are used to determine which encounter to bill when a patient has multiple same-day encounters with more than one provider at the same location with the same encounter rate payer attached. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Parent topic: Practice Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Bill Multiple Encounters (Batch Billing)

All encounters in Unbilled or Rebill status with charges can be billed at the same time in a batch. Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. Select Bill Status, and then select Rebill and Unbilled. Note: Encounters with a status of Bad Debt, Billed or History have already been billed. Clear the Include records without charges check box to exclude encounters that do not have charges. Enter additional Search Criteria to locate the desired encounters. Select Find. Encounters matching the search criteria appear in the Encounter List section of the window. Select Encounter List, and then select all encounters to be billed in the Enc Nbr column. Right-click the encounter and select Bill. A message appears stating that confirm bill processing for the [n] selected encounters. To continue billing the selected encounters, select OK. The encounters go through the claim edits process and the Claim Production Status report appears. Each encounter is listed o

Help Guide for NextGen® Enterprise PM 8

Multiple Encounter Rates Per Day Report

The Multiple Encounter Rates Per Day report enables you to track and report on patients that have multiple same day/same payer encounters where Encounter Rate Billing may have applied an encounter rate SIM code and dollar amount to more than one encounter for the day. Note: This report is available only if Encounter rate billing is enabled in Enterprise Preferences > General tab. Data on the report can be filtered using options available on the Report Filter window: Filter 1 options include Encounter Date range, Payer Type, and the ability to include or exclude Encounter Rate Billing Statuses for primary and/or secondary encounter rate payers. The Encounter Rate Billing Status is updated for encounters on Encounter Maintenance > Billing & Collections tab during the billing process. Statuses include the following: Undecided Multi Yes Multi No ER Applied Exempt Non ER Payer Filter 2 options include Between, Equals, Not Equals, Greater Than, Less Than and/or Like filters that can be used

Billing Status for Multiple Same-Day Encounters

Recommendations

Encounter Rate Billing Status

Set Up the General Tab

Set Up the General Tab

Enable Qualifying Encounter Billing

Bill Multiple Encounters (Batch Billing)

Multiple Encounter Rates Per Day Report

Encounter Rate Billing Status

Set Up the General Tab

Set Up the General Tab

Enable Qualifying Encounter Billing

Bill Multiple Encounters (Batch Billing)

Multiple Encounter Rates Per Day Report