Medical Direction for Anesthesia Billing

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for Anesthesia Billing

The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments. On the Anesthesia Library Payer Maintenance window, select the SIM Options tab. Select Open Menu and select New. The SIM Range window opens. In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK. Select (highlight) the SIM range and use the following table to define SIM Options parameters for the selected SIM range and Valid Payers. To save changes and close the window, select OK. Field Description Exempt from Concurrency Select this check box to exclude the selected SIM range from being counted against max concurrency (not a concurrent case) for the selected payers. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the SIM is ignored during calculation of concurrent ch

Help Guide for NextGen® Enterprise PM 8

Provider Specialty Mappings for Anesthesia Billing

The Provider Specialty Mapping in the Anesthesia library are used to calculate medical direction when the Anesthesia Concurrency Audit process is run in NextGen Enterprise PM. In addition, the specialties selected for Medical Directors, CRNAs and AAs are used to limit the providers that are available for selection in the following fields in NextGen Enterprise PM: MD Anesthesia: This field appears on the Encounter Maintenance > General tab and is limited to a list of Medical Directors. This allows you to select an encounter-level Medical Director. MD Anesth: This field appears on the Charge Posting window and is limited to a list of Medical Directors. This allows you to select a charge-level Medical Director. Anesthesia Provider: This field appears on the Encounter Lookup window and is limited to a list of Medical Directors, CRNAs and AAs. This allows you to select one or more anesthesia providers for encounter lookup. Note: The Anesthesia library must be selected in Practice Preference

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options for Anesthesia Billing

The Claim Options tab on the Anesthesia Library Payer Maintenance window enables you to define whether surgical procedure codes are sent on claims, and which anesthesia provider is sent on claims as the rendering. These rules determine which provider goes on the claim and includes the following criteria: Determines which anesthesia provider goes on the claim as the rendering provider when there is more than one anesthesia service line such as in relief and discontinuous time scenarios. If None is selected, then claims create using the standard claim splitting rules. Each unique provider’s charge goes on a separate claim. If no MDA is present on the encounter or charge, the provider entered as the Rendering provider on the encounter or charge, regardless of specialty, populates as the rendering on the claim. On the Anesthesia Library Payer Maintenance window, select the Claim Options tab. Define Claim Options parameters for the selected valid payer(s): Send surgical as SV item: Select t

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

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

Add or Modify an Anesthesia Library

Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Do one of the following: To create a new library, select open menu button and select New. To modify an existing library, select the library from the list, and then select open menu button and select Open. The Anesthesia Library Maintenance window opens. In the Anesthesia Library Name field, enter a name for the library. This field is required. In the Provider Specialty Mapping section, select the appropriate specialties for all Medical Directors, CRNAs and Anesthesiologist Assistants in the practice. These fields are required. Note: The specialties available for selection are from the Specialties master file in File Maintenance. The appropriate specialty must be linked to each anesthesia provider in the Providers master file, on the Practice tab, in the Specialty field. In the Default Anesthesia Concurrency Audit Report field, select a previously memorized version of the Anesthesia

Medical Direction for Anesthesia Billing

Recommendations

Set Up SIM Options for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Add or Modify an Anesthesia Library

Set Up SIM Options for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Set Up Claim Options for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Add or Modify an Anesthesia Library