Enable Qualifying Encounter Billing

Help Guide for NextGen® Enterprise PM 8

Practice Preferences for Encounter Rate Billing

To use encounter rate billing in NextGen® Enterprise PM, specific options must be enabled for the practice in Practice Preferences. Enable Qualifying Encounter Billing Process Date for Encounter Rate SIM and Adjustments Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Enterprise Preferences for Encounter Rate Billing

You must enable encounter rate billing for the enterprise. When enabled, further setup can be completed for practices within the enterprise that use encounter rate billing functionality. This also enables an Encounter Rate Billing library to be attached to the appropriate payers later in the setup. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Enterprise. The Enterprise Preferences window appears. Select the General tab. Select the Encounter rate billing check box. Enterprise Preferences To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounter Rate Billing

Encounter rate billing in NextGen® Enterprise PM involves the following setup in System Administrator and File Maintenance: Security Access Rights Enterprise Preferences Practice Preferences CPT4 Codes Revenue Codes Departments Service Items Library Claim Edits Library Transaction Codes Encounter Rate Billing Library Payers Set Up Security Access Rights for Encounter Rate Billing Set Up Enterprise Preferences for Encounter Rate Billing Practice Preferences for Encounter Rate Billing Add or Modify CPT4 Codes for Encounter Rate Billing Add or Modify Revenue Codes for Encounter Rate Billing Add or Modify Departments for Encounter Rate Billing Add or Modify SIM Codes for Encounter Rate Billing Set Up Claim Edits for Encounter Rate Billing Add or Modify Transaction Codes for Encounter Rate Billing Add or Modify an Encounter Rate Billing Library Set Up Payers for Encounter Rate Billing Parent topic: Encounter Rate Billing

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

Billing Status for Multiple Same-Day Encounters

If a patient has multiple same day encounters for the same encounter rate payer, the setting for Multiple Patient Encounters per Day in the Encounter Rate Billing library on the General tab determines how the encounters are handled during the billing process in NextGen® Enterprise PM. PM Selection: If selected in the library, the system automatically changes the Billing Status on the first same day/same payer encounter identified during the billing process from Undecided to Multi Yes. A claim is created for the Multi Yes encounter. The Billing Status on other same day/same payer encounters remains as Undecided and claims are suppressed from being created. Note: The Suppress claim for multiple same-day encounters option must be enabled on the Primary Encounter Rate tab of the Encounter Rate Billing library . Manual Selection: If selected in the library, users must determine which encounter should be billed and create a claim. After the billing process runs, the Billing Status on same da

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

Enable Qualifying Encounter Billing

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Practice Preferences for Encounter Rate Billing

Set Up Enterprise Preferences for Encounter Rate Billing

Setting Up Encounter Rate Billing

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Billing Status for Multiple Same-Day Encounters

Encounter Rate Billing Status

Practice Preferences for Encounter Rate Billing

Set Up Enterprise Preferences for Encounter Rate Billing

Setting Up Encounter Rate Billing

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Billing Status for Multiple Same-Day Encounters

Encounter Rate Billing Status