Exempt SIM Codes from Encounter Rate Billing

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

Exempt SIM Codes from Encounter Rate Billing

If there is a service item that is exempt from encounter rate billing, you must flag it as Encounter Rate Exempt in the Service Items library. This flag makes the SIM code exempt from encounter rate billing for all payers. Note: To flag a SIM code as exempt for a specific encounter rate payer, you must select the Exclude from Encounter Rate Insertion check box on the Claim SIM Options tab of the Encounter Rate Billing library. 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. In the Search field, enter the SIM code and then select the code from the list. On the General tab, select the Enc rate exempt check box. Service Item Library Maintenance To save changes and close the window, select OK. Note: The Enc rate exempt setting in the SIM library works in conjunction with the Encounter Rate Exempt option on the

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 the General Billing Rule Options

Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button and then select Open. The Encounter Rate Billing Library Maintenance window opens. Select the General tab. In the Encounter Rate Exempt setting, do the following: Disqualify patient encounter from ER billing if: Select one of the following options to set the basis for disqualifying an encounter from encounter rate billing: All SIMs are ER exempt Only one SIM is ER exempt Suppress claim for disqualified patient encounter: Select this option to suppress the claim for any encounter that is disqualified from encounter rate billing based on exempt SIM codes. Note: Encounter Rate Exempt settings apply only when one or more of the charge line SIM codes are flagged as Enc rate exempt in the Service Items library

File Maintenance Help for NextGen® Enterprise 8

Set Up the Claim SIM Options Tab

The Claim SIM Options tab on the Encounter Rate Billing Library Maintenance window contains options that provide the capability to show non-Encounter Rate SIMs on claims or affect automatic adjustments. Open an Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claim SIM Options tab. In the Claim Service Range Options section, select open menu button and select New. The Alt Payer Number SIM Range window opens. Enter the SIM number or the beginning SIM number for a range of SIMs that you want to apply to a claim SIM option. For a range of SIM numbers, enter the ending SIM number. The ending SIM is required, but can be the same as the beginning SIM, functionally choosing that as a single SIM. Select OK. The claim SIM options are available for selection. Select the applicable option based on the following descriptions: Exclude from Encounter Rate Insertion: Select this option to make the service exempt from the Encounter Rate. This opti

Help Guide for NextGen® Enterprise PM 8

Set Up the Claim SIM Options Tab

The Claim SIM Options tab on the Encounter Rate Billing Library Maintenance window contains options that provide the capability to show non-Encounter Rate SIMs on claims or affect automatic adjustments. Open an Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claim SIM Options tab. In the Claim Service Range Options section, select open menu button and select New. The Alt Payer Number SIM Range window opens. Enter the SIM number or the beginning SIM number for a range of SIMs that you want to apply to a claim SIM option. For a range of SIM numbers, enter the ending SIM number. The ending SIM is required, but can be the same as the beginning SIM, functionally choosing that as a single SIM. Select OK. The claim SIM options are available for selection. Select the applicable option based on the following descriptions: Exclude from Encounter Rate Insertion: Select this option to make the service exempt from the Encounter Rate. This opti

Exempt SIM Codes from Encounter Rate Billing

Recommendations

Add or Modify SIM Codes for Encounter Rate Billing

Exempt SIM Codes from Encounter Rate Billing

Add or Modify SIM Codes for Encounter Rate Billing

Set Up the General Billing Rule Options

Set Up the Claim SIM Options Tab

Set Up the Claim SIM Options Tab

Exempt SIM Codes from Encounter Rate Billing

Add or Modify SIM Codes for Encounter Rate Billing

Exempt SIM Codes from Encounter Rate Billing

Add or Modify SIM Codes for Encounter Rate Billing

Set Up the General Billing Rule Options

Set Up the Claim SIM Options Tab

Set Up the Claim SIM Options Tab