Process Date for Encounter Rate SIM and Adjustments

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

Set Up the Process Date for Encounter Rate SIM and Adjustments

To define how the process dates are assigned to Encounter Rate SIM charges and auto-adjustments, do the following: Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select General. In the Set Process Date for Encounter Rate SIM and Encounter Rate Adjustments as field, select one of the following: Current Process Date (default): Select this option to use the current system date as the process date. This is legacy functionality in versions prior to version 5.9. First charge line Process Date or Minimum Process Date, whichever is later: Select this option to use the process date from the first charge on the encounter, or use the Minimum Override Process Date defined from the File > Processes > Override Process Date. Practice Preferences To save changes and close the window, select OK. Parent topic: Process Date for Encounter Rate SIM and Adjustments

Help Guide for NextGen® Enterprise PM 8

Practice Preferences for Encounter Rate Billing

To use encounter rate billing in NextGen® Enterprise PM, specific options must be enabled for the practice in Practice Preferences. Enable Qualifying Encounter Billing Process Date for Encounter Rate SIM and Adjustments Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Encounter Rate Billing

Encounter Rate Billing is an option for payers such as Medicare (FQHC and RHC) and Medicaid that have very unique and specific billing and claim requirements, and that reimburse at a flat encounter rate. Encounter Rate Billing provides the ability to automatically adjust charges so that the balance reflects the payer’s expected encounter reimbursement rate or amount. In addition, an encounter rate code required by the payer on claims can be automatically inserted onto each encounter. For example, a 0521 Revenue Code line item may be required on Medicare UB/837I claims, and a T1015 CPT4 Code line item may be required on Medicaid 1500/837P claims. The setup and configuration of the Encounter Rate Billing library also defines which of the original charge line items on an encounter are included on the claim. Note: FQHC practices must use encounter rate billing for Medicare. It is the only option available that meets CMS’s complex requirements and guidelines for claims. The encounter rate b

Help Guide for NextGen® Enterprise PM 8

Encounters in NextGen® Enterprise PM

An encounter is an interaction between a patient and a provider in the practice on a specific date and time. In NextGen® Enterprise PM, office encounters are typically created from the appointment book when each patient checks in for their appointment. Facility encounters that are not related to an appointment, such as hospital and nursing home visits, can be created from the patient's chart. Clinical information related to a specific encounter is documented by the provider in NextGen® Enterprise EHR. Financial information, such as charges, billing and transactions, is entered on that same encounter by users in NextGen® Enterprise PM. The Encounters tab on Patient Chart lists all encounters for a patient, and the Encounters Detail tab on Account Profile lists all encounters for a guarantor. For more information on encounters in NextGen® Enterprise EHR, go to the NextGen Healthcare Success Community and download the Layout and Preferences Guide for NextGen® Enterprise EHR. Encounter Sta

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

Process Date for Encounter Rate SIM and Adjustments

Recommendations

Enable Qualifying Encounter Billing

Set Up the Process Date for Encounter Rate SIM and Adjustments

Practice Preferences for Encounter Rate Billing

Encounter Rate Billing

Encounters in NextGen® Enterprise PM

Set Up Payers for Encounter Rate Billing

Enable Qualifying Encounter Billing

Set Up the Process Date for Encounter Rate SIM and Adjustments

Practice Preferences for Encounter Rate Billing

Encounter Rate Billing

Encounters in NextGen® Enterprise PM

Set Up Payers for Encounter Rate Billing