Medical Direction Field Descriptions

Field	Description
Concurrency Modifiers:
Personally performed by a Physician	Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, `AA`.
CRNA performing without medical direction	Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, `QZ`.
Medical Direction of 1 Case:
Medical Director	Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, `QY`.
CRNA	Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, `QX`.
Medical Direction of 2-4 Cases:
Medical Director	Enter a two-character modifier indicating the anesthesiologist provided medical direction for 2-4 CRNA cases. For example, `QK`.
CRNA	Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, `QX`.
Medical Direction of 5+ Cases:
Medical Director	Enter a two-character modifier indicating the anesthesiologist provided medical direction for 5 or more CRNA cases. For example, `AD`.
CRNA	Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, `QX`.
Reduced base units	The base units for the Medical Director charge line service is reduced to this value when the maximum number of concurrent encounters is exceeded. The default value is 3. The total anesthesia units for the MDA is equal to the reduced base unit price and the Present at Induction time unit if it is checked in the Anesthesia Services Information window. Time and other modifying units are not included in the MDA claim. CRNA claims are not affected.

File Maintenance Help for NextGen® Enterprise 8

Medical Direction Field Descriptions

In the Medical Direction of 1 Case, Medical Direction of 2-4 Cases, and Medical Direction of 5+ Cases sections, if a modifier is assigned to either the CRNA or the Medical Director but not both, then split billing does not occur. Split billing occurs when a modifier is assigned to both the Medical Director and the CRNA. Field Description Concurrency Modifiers: Personally performed by a Physician Enter a two-character modifier indicating the anesthesiologist performed the case alone. For example, AA. CRNA performing without medical direction Enter a two-character modifier indicating the CRNA performed the case alone without medical direction by an anesthesiologist. For example, QZ. Medical Direction of 1 Case: Medical Director Enter a two-character modifier indicating the anesthesiologist provided medical direction for one CRNA case. For example, QY. CRNA Enter a two-character modifier indicating the CRNA performed a case with medical direction by an anesthesiologist. For example, QX. M

Help Guide for NextGen® Enterprise PM 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

File Maintenance Help for NextGen® Enterprise 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

Help Guide for NextGen® Enterprise PM 8

Disable Rendering Claim Breaks

Disable Rendering Claim Breaks is used in relief and discontinuous time scenarios to determine which rendering or MD Anesthesia goes on the claim as the rendering provider. When there is more than one anesthesia service line. Claims are created by the rules set in File Maintenance > Libraries > Anesthesia > Anesthesia Library Payer Maintenance > Claim Options tab. If you do not select any options on this window, then claims are created using existing claim splitting rules. The following options are available for selection to identify the rendering provider or MDA to go on the claim when there is more than one anesthesia service line: Option Description Use Encounter MDA (intended for non-split billing) Uses the Encounter MDA Anesthesia for non-split billing, if there is no MDA then it uses the Encounter Rendering. Use Encounter Rendering (intended for split billing) Uses the Encounter MDA on the MDA claim and Encounter Rendering on the CRNA claim. Use MDA from First Anesthesia Charge L

File Maintenance Help for NextGen® Enterprise 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

Help Guide for NextGen® Enterprise PM 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

Medical Direction Field Descriptions

Recommendations

Medical Direction Field Descriptions

Medical Direction for Anesthesia Billing

Medical Direction for Anesthesia Billing

Disable Rendering Claim Breaks

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Medical Direction Field Descriptions

Medical Direction Field Descriptions

Medical Direction for Anesthesia Billing

Medical Direction for Anesthesia Billing

Disable Rendering Claim Breaks

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing