Do Not Sum Units for CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific CPT4 code. This option is rarely used. It could be used for any payer that requires multiple services to be rolled-up to a single CPT4 code line item on the claim. Note: Best practice is to use encounter rate billing for both Medicare and Medicaid. In some cases, roll-up by CPT4 code will not meet the billing and claim requirements for a payer (e.g. FQHC/RHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With the setup, all SIM codes on an encounter with the same Alternate CPT4 Code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-up charges. In order for ch

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

To set up a SIM code for roll-up billing by CPT4 code, 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 a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate revenue code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional se

Help Guide for NextGen® Enterprise PM 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

File Maintenance Help for NextGen® Enterprise 8

Claim Options Field Descriptions

Use the following table to setup claim options. Field Description Force Claim Break when Place of Service is Select one or more Place of Service codes that will cause charges with the selected POS to break to a separate claim, if applicable. Always send unit count as 1 on claim charge lines Select this check box if the number of charge units should always be sent as 1 on claims, regardless of the actual charge units. For example, the number of units based on time for a charge is 3. If this option is selected, the number of units on the claim for that charge will be 1. Note: If enabled, claim edit #273 “CPT4(s) cannot be in excess of a particular number of units” should be disabled in File Maintenance > Libraries > Claim Edits. Always send one line item per claim Select this check box if claims should only include 1 line item. For example, an encounter has three charges. Two of the charges roll-up and the third charge is not part of the roll-up. If this option is selected, two claims wi

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements. With this setup, all SIM codes on an encounter with the same revenue code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-u

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code requires specific settings in the Payers master file. Each payer that is to roll-up to a single CPT4 code line on the claim must have the CPT on Rev Code Roll-up option selected so that the CPT4 code appears in Field Locator 44 on UB claims. Also, the Ignore modifiers on roll-up option must be selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Defaults-2 tab. Select the CPT on Rev Code Roll-up check box. Add Payer Information Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. To

Do Not Sum Units for CPT4 Code

Recommendations

Roll-Up Billing by CPT4 Code

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Claim Options Field Descriptions

Claim Options Field Descriptions

Roll-Up Billing by Revenue Code

Set Up Payers for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Claim Options Field Descriptions

Claim Options Field Descriptions

Roll-Up Billing by Revenue Code

Set Up Payers for Roll-Up Billing by CPT4 Code