Example: Roll-Up Billing by CPT4 Code

Charge	Alt CPT4 Code	Amount	Preventive/Non-Preventive
99212	0521	$95.00	Non-Preventive
11301	0521	$150.00	Non-Preventive
76090		$200.00	Preventive

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code and Transactions

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within thePayertab on theService Itemslibrary. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line The payer remits a $90.00 payment on the 0521 CPT4/HCPCS code line item. Because the encounter does not include the 0521 line item, the payment must be posted manually against the original charges. Adjustments are also posted manually against the original charges so the appropriate balances

Help Guide for NextGen® Enterprise PM 8

Example: Roll-Up Billing by CPT4 Code

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within the Payer tab on the Service Item library. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line Parent topic: Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code and Transactions

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within thePayertab on theService Itemslibrary. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line The payer remits a $90.00 payment on the 0521 CPT4/HCPCS code line item. Because the encounter does not include the 0521 line item, the payment must be posted manually against the original charges. Adjustments are also posted manually against the original charges so the appropriate balances, if any, can b

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

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

The following charges are entered on an example Medicare (RHC) encounter: Charge Revenue Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 0403 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created for Medicare Part A that meets the specific billing requirements for an RHC. The appearance of the claim is a result of parameters defined within the Payer tab of the Service Item library. Claim Line 1: Includes the Revenue Code (0521) and no CPT4/HCPCS code. The total charge amount is equal to the sum of all non-preventive services that rolled-up because they have the same Revenue Code. Claim Lines 2 - n: Preventive services are listed separately on the claim with their corresponding Revenue Code, CPT4/HCPCS code, and charge amount. Claims Parent topic: Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

The following charges are entered on an example Medicare (RHC) encounter: Charge Revenue Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 0403 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created for Medicare Part A that meets the specific billing requirements for an RHC. The appearance of the claim is a result of parameters defined within the Payer tab of the Service Item library. Claim Line 1: Includes the Revenue Code (0521) and no CPT4/HCPCS code. The total charge amount is equal to the sum of all non-preventive services that rolled-up because they have the same Revenue Code. Claim Lines 2 - n: Preventive services are listed separately on the claim with their corresponding Revenue Code, CPT4/HCPCS code, and charge amount. Claims Parent topic: Roll-Up Billing by Revenue Code

Example: Roll-Up Billing by CPT4 Code

Recommendations

Roll-Up Billing by CPT4 Code and Transactions

Example: Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code and Transactions

Roll-Up Billing by CPT4 Code

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

Example: Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code and Transactions

Example: Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code and Transactions

Roll-Up Billing by CPT4 Code

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)