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

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

File Maintenance Help for NextGen® Enterprise 8

Exempt SIM-Related Charges

You can exempt SIM-related charges from encounter bills and statements. Exempt charges display in the Charge Posting window line item listing, but are not added to the total charge for the encounter. Open a Service Item library and then select a SIM. Set the following fields: Encounter billing exempt : Select this check box to not add the charge associated with the SIM to the patient's encounter bill or statement. If a SIM is set up to be Encounter billing exempt, then it will essentially be written off 100% (auto-adjustment) to the corresponding Encounter Exempt Patient Adjustment Code. While this charge will still appear in the Charge Entry window and the Encounter registers, it will NOT appear on anything going to a patient (such as statement, encounter bill, or invoice). Exempt patient adjustment code: When you select the Encounter billing exempt check box, you must select an Exempt pat adj code to indicate the reason that the SIM charge is exempt. Parent topic: General Tab

File Maintenance Help for NextGen® Enterprise 8

Add or Modify an Encounter Rate Billing Library

Before you begin A SIM with the appropriate CPT4 code must be set up in the SIM Library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing Library, the SIM configuration hierarchy and the encounter rate information are also copied. Encounter Rate Billing Library provides flexibility to set up multiple rate codes to accommodate different billing requirements of individual payers. You can generate both Encounter Rate Library Listing and Encounter Rate Library with Claim Detail Rules reports from the Encounter Rate Billing Library. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide forNextGen®Enterprise PM. To add or modify an Encounter Rate Billing Library, do the following: 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,

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer. A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing library, the SIM Configuration Hierarchy and the encounter rate information are also copied. To add or modify an Encounter Rate Billing library, do the following: Access File Maintenance. Select Libraries, and then Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select Open Menu and select New. To modify a library, select the library from the list, and

Exempt SIM Codes from Encounter Rate Billing

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Add or Modify SIM Codes for Encounter Rate Billing

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