Enter a Charge-Level Narrative for an ER SIM Code

Help Guide for NextGen® Enterprise PM 8

Enter an Encounter-Level Narrative for an ER SIM Code

If the Encounter Rate Library for the payer is setup to insert the ER SIM into encounter maintenance, then the ER SIM automatically inserts on the Encounter Rate sub-tab on the Billing & Collections tab of the Encounter Maintenance window when the encounter is billed. An encounter-level narrative can be manually entered for an Encounter SIM either before or after the encounter is billed. Access Patient Chart for the desired patient. Select the Encounters tab. Double-click to open the desired encounter. The Encounter Maintenance window appears. Select the Billing & Collections tab, and then the Encounter Rate sub-tab. In the Narrative field for the primary, secondary or tertiary encounter rate payer, enter a free-text comment for the ER SIM. The maximum is 80 characters. If the encounter is in Unbilled status prior to entering the narrative, select OK to save changes and close the window. If the encounter is in Billed status prior to entering the narrative, you get a prompt asking if yo

Help Guide for NextGen® Enterprise PM 8

Encounter Rate SIM Narrative for Claims

The Narrative field on the Charge Posting window, or on the Encounter Rate sub-tab on the Billing & Collections tab of the Encounter Maintenance window, can be used to enter a free-text narrative, or comment, for the ER SIM code on the encounter. This populates the narrative segment for the ER SIM on claims for the primary, secondary or tertiary encounter rate payer. Charge-Level Narrative To include a charge-level narrative for an ER SIM on claims, the Encounter Rate Billing library for the payer must include the following settings on the Claims tab: Display narrative on ER SIM charge Line? = Yes From what field should the narrative data pull from? = Charge Entry If a narrative exists on the Charge Posting window for the ER SIM charge line, then it is used on the claim. If the narrative for the ER SIM charge line is blank, then the narrative for the first charge line is used on the claim. Charge Posting Encounter-Level Narrative To include an encounter-level narrative for an ER SIM on

Help Guide for NextGen® Enterprise PM 8

Rebill an Encounter using Balance Control

Encounters that have already been billed to insurance can be rebilled for a variety of reasons. For example, a new charge can be added to the encounter, an existing charge can be corrected and modified, or insurance has not responded to the initial claim. Balance Control is used to flag one or more charges on an encounter to be rebilled to insurance. To flag all the charges to be rebilled, do the following: Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter, and then select the Balance Control icon. The Balance Control window opens. Right-click in the R (Release to Bill) column for the payer to be rebilled. Select Select All Ins. All line items show check mark in the R (Release to Bill) column, the encounter status changes to Rebill, and the Rebill Encounter check box is automatically selected. To save changes and close the window, select OK. To flag specific charges to be rebilled, do the following: Open the Balance C

Help Guide for NextGen® Enterprise PM 8

Add or Modify SIM Codes for Encounter Rate Billing

In the Service Items library, you must create an Encounter Rate SIM code for each Encounter Rate CPT4 code. To add or modify a SIM code for encounter rate billing, 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 an Encounter Rate SIM code, select Open Menu and select New. To modify an Encounter Rate SIM code, search for the code and then select the code from the list on the left. Service Item Library Maintenance In the CPT4 Code field, enter the encounter rate CPT4 code and then press Tab. In the two Modifier fields, press Tab to leave the fields blank. The Service Item # field automatically defaults to the encounter rate CPT4 code. Press Tab. The Description field automatically defaults to the description for the encounter rate CPT4 code. Press Tab. On the

Help Guide for NextGen® Enterprise PM 8

Set Up Encounter Rate SIM Maintenance Configurations

After you set the SIM configuration hierarchy, you must set up specific parameters for the encounter rate SIM code. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Select a library from the list. The Encounter Rate Billing Library Maintenance window opens. Right-click the Encounter Rate SIM grid, and then select New. The Encounter Rate SIM Maintenance window opens. Encounter Rate SIM Maintenance window Enter the service item number. Select the effective and expiration dates. Enter the co-pay amount. Select a condition code for Field Locator 18 on UB claims. Note: The Description and Amount fields are automatically filled in based on the service item description for the encounter and the corresponding dollar value from the SIM. You can modify the values. Optional: In the Required CPT4 section, select the open record button, and then select the codes. Select the payer in COB. Optional: In the Valid Primary Payers section, se

File Maintenance Help for NextGen® Enterprise 8

Set Up the Primary Encounter Rate Tab

The Primary Encounter Rate tab on the Encounter Rate Billing Library Maintenance window contains billing rules that apply when the ER payer is the primary on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Primary Encounter Rate tab. Set the Suppress Claim Creation setting. The option is: Suppress claim for multiple same-day encounters (Multi-Yes only): Select this option to suppress the creation of a claim for an encounter with a status of Multi-no if there are multiple encounters per day. Set the Encounter Rate Calculation setting. The option is: Add 20% of original charge line items to encounter rate amount: Select this option to calculate 20% of the original charge amounts and add that to the encounter rate amount before inserting the new charge on the encounter. Set the Auto Adjustments settings. These settings have no impact on alternate payer charge lines. The option is: Adjust remaining balance of c

Enter a Charge-Level Narrative for an ER SIM Code

Recommendations

Enter an Encounter-Level Narrative for an ER SIM Code

Encounter Rate SIM Narrative for Claims

Rebill an Encounter using Balance Control

Add or Modify SIM Codes for Encounter Rate Billing

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the Primary Encounter Rate Tab

Enter an Encounter-Level Narrative for an ER SIM Code

Encounter Rate SIM Narrative for Claims

Rebill an Encounter using Balance Control

Add or Modify SIM Codes for Encounter Rate Billing

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the Primary Encounter Rate Tab