Practice Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Enterprise Preferences for Encounter Rate Billing

You must enable encounter rate billing for the enterprise. When enabled, further setup can be completed for practices within the enterprise that use encounter rate billing functionality. This also enables an Encounter Rate Billing library to be attached to the appropriate payers later in the setup. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Enterprise. The Enterprise Preferences window appears. Select the General tab. Select the Encounter rate billing check box. Enterprise Preferences To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Enable Qualifying Encounter Billing

The Encounter Rate Billing functionality in NextGen® Enterprise PM includes logic that identifies multiple encounters for a patient on the same date of service at the same location with the same encounter rate payer. Qualifying Encounter Billing must be enabled for the practice. When enabled, the Encounter Rate Billing Status fields display on the Billing & Collections tab of the Encounter Maintenance window. These fields are used to determine which encounter to bill when a patient has multiple same-day encounters with more than one provider at the same location with the same encounter rate payer attached. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Parent topic: Practice Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounter Rate Billing

Encounter rate billing in NextGen® Enterprise PM involves the following setup in System Administrator and File Maintenance: Security Access Rights Enterprise Preferences Practice Preferences CPT4 Codes Revenue Codes Departments Service Items Library Claim Edits Library Transaction Codes Encounter Rate Billing Library Payers Set Up Security Access Rights for Encounter Rate Billing Set Up Enterprise Preferences for Encounter Rate Billing Practice Preferences for Encounter Rate Billing Add or Modify CPT4 Codes for Encounter Rate Billing Add or Modify Revenue Codes for Encounter Rate Billing Add or Modify Departments for Encounter Rate Billing Add or Modify SIM Codes for Encounter Rate Billing Set Up Claim Edits for Encounter Rate Billing Add or Modify Transaction Codes for Encounter Rate Billing Add or Modify an Encounter Rate Billing Library Set Up Payers for Encounter Rate Billing Parent topic: Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Encounter Rate Billing in NextGen® Enterprise PM

This section provides information about specific functionality in NextGen® Enterprise PM related to encounter rate billing. Encounter Rate Billing Status Encounter Rate SIM Codes Encounter Rate SIM Narrative for Claims Reverse Encounter Rate Adjustments Parent topic: Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Process Date for Encounter Rate SIM and Adjustments

Some payers, such as Medicare for a Federally Qualified Health Center (FQHC), require that an encounter rate SIM code, or payment code, be included on claims to describe the type of visit. For example, code G0466 on a Medicare claim indicates a new patient visit, and code G0467 indicates an established patient visit. The Encounter Rate Billing library in File Maintenance can be setup for a payer to automatically insert the ER SIM code, or payment code as an additional charge line on encounters during the billing process in NextGen® Enterprise PM. With this setup, there is the potential for an ER SIM charge inserted by the system to have a process date that is different from the process dates on the original charge lines. For example, the original charges on an encounter may have been entered and processed on 2/28/17, but the encounter was not billed until 3/2/17. In this scenario, the original charges have a process date in the February accounting period, and the ER SIM charge on the s

Practice Preferences for Encounter Rate Billing

Recommendations

Set Up Enterprise Preferences for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Enable Qualifying Encounter Billing

Setting Up Encounter Rate Billing

Encounter Rate Billing in NextGen® Enterprise PM

Process Date for Encounter Rate SIM and Adjustments

Set Up Enterprise Preferences for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Enable Qualifying Encounter Billing

Setting Up Encounter Rate Billing

Encounter Rate Billing in NextGen® Enterprise PM

Process Date for Encounter Rate SIM and Adjustments