Encounter Rate Billing Status

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 selected to indicate that encounter rate billing should apply during the rebilling process and a claim should be created for the encounter.
Multi No	Used when multiple same day encounters exist for the same encounter rate payer. This status is selected to indicate that encounter rate billing should not apply during the rebilling process and a claim should not be created for the encounter.
Non ER Payer	Indicates the encounter was billed and that encounter rate billing was not applied during the billing process because the payer is not an ER payer.

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

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

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

Encounter Status

The following table lists the encounter status and its definition. Status Definition Unbilled An encounter has been created, and charges may have been entered, but have not gone through the Bill process. Anesthesia encounters convert to unbilled only when the Use Convert In Progress Indicator check box is selected in NextGen® Enterprise PM Preferences > Practice > Encounters Billed The encounter has successfully gone through the Edit process and has been billed. History The encounter has gone through the Bill process and the balance is equal to zero. Rebill The encounter has been modified, or charges or insurance were added that warrant a new generation of a claim. For example, A charge needs to be submitted to a secondary or tertiary insurance. A new charge has been added to an encounter that previously had a History status. You have selected charges to be billed again through Balance Control. Bad Debt Encounter has been pre-listed for a collection agency. In Progress An encounter tha

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

Bill an Individual Encounter from Encounter Lookup

Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. In the Bill Status field, select Rebill or 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 encounter. Select Find. Encounters matching the search criteria display in the Encounter List section of the window. Select Encounter List, and then select the encounter to be billed in the Enc Nbr column. Right-click the encounter, and then select Bill. If the encounter is a self-pay encounter with no insurance attached, a message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The en

Encounter Rate Billing Status

Recommendations

Billing Status for Multiple Same-Day Encounters

Multiple Encounter Rates Per Day Report

Enable Qualifying Encounter Billing

Encounter Status

The Billing Process

Bill an Individual Encounter from Encounter Lookup

Billing Status for Multiple Same-Day Encounters

Multiple Encounter Rates Per Day Report

Enable Qualifying Encounter Billing

Encounter Status

The Billing Process

Bill an Individual Encounter from Encounter Lookup