Rebill a Batch for Secondary Insurance

Help Guide for NextGen® Enterprise PM 8

Bill Multiple Encounters (Batch Billing)

All encounters in Unbilled or Rebill status with charges can be billed at the same time in a batch. Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. Select Bill Status, and then select Rebill and Unbilled. Note: Encounters with a status of Bad Debt, Billed or History have already been billed. Clear the Include records without charges check box to exclude encounters that do not have charges. Enter additional Search Criteria to locate the desired encounters. Select Find. Encounters matching the search criteria appear in the Encounter List section of the window. Select Encounter List, and then select all encounters to be billed in the Enc Nbr column. Right-click the encounter and select Bill. A message appears stating that confirm bill processing for the [n] selected encounters. To continue billing the selected encounters, select OK. The encounters go through the claim edits process and the Claim Production Status report appears. Each encounter is listed o

Help Guide for NextGen® Enterprise PM 8

Billing Process Work Flow

After charges are applied to an encounter, you can: Bill the encounter to the guarantor (for encounters with no attached insurance) - or - Bill the encounter to a payer (for encounters with attached insurance). You can bill only those encounters with an Unbilled (U) or a Rebill (R) encounter status. To bill a single encounter, access the Chart > Encounters tab, right-click on the encounter you want to bill, and select Bill from the menu. To bill multiple encounters at once (Batch billing), access the Encounter Lookup window, enter search criteria to locate Unbilled encounters, select the encounters you want to bill from the list of matching records, right-click and select Bill from the short-cut menu. You can review the charges applied to the encounter in the Encounter Bill window. For encounters with insurance, the application generates a claim by checking the encounter against the Claim Edits that are configured in the Claim Edits library. The results of this Claim Edit check display

Help Guide for NextGen® Enterprise PM 8

Batch Status

You can use the batch Status for payment batches to indicate the flow of the line item balance. For example, if the Payer field is set to the primary payer, the charge settles to the secondary payer or to the patient if there is no secondary payer. Note: The patient responsibility date is the first date when responsibility for encounter payment falls completely in the patient bucket. In other words, you expect no payment from insurance, or insurance has already paid and the entire encounter balance is left for the patient. In addition to settling the encounter to the next payer, you can also enter a status of Rebill, Appeal, or Deny . The following table lists how each status affects the encounter status and its status in Balance Control. Transaction Status New Status of encounter after posting the transaction Balance Control Settled (if there is another payer) R Next Payer Settled (if there is no other payer) B Patient Rebill R Same Payer Appeal B None Deny B None Forward to B Forward

Help Guide for NextGen® Enterprise PM 8

Balance Control

Balance Control performs the following: Rebill encounter Reorder encounter insurances Add encounter insurance Reassign encounter balances Prorate charge balances Note: Access to Balance Control is dependent on security access rights in System Administrator > Group Rights > Modules > Transactions > Balance Control. If you attach the initial Balance Control for an unbilled encounter with primary and secondary insurances and enter the charges on the encounter, all charges are flagged with a check mark on the R (Release to Bill) column for billing to primary insurance. The patient is responsible for a co-pay amount on the first charge, and primary insurance is responsible for the remaining charge balances. When the encounter has gone through the billing process and a claim is successfully created for the primary insurance, the check marks on the R (Release to Bill) column disappear. You can view Balance Control Tips window by selecting the Charge Information icon. The window provides infor

Help Guide for NextGen® Enterprise PM 8

Rebill an Encounter using Balance Control

Encounters that have already been billed to insurance can be rebilled for a variety of reasons. For example, a new charge can be added to the encounter, an existing charge can be corrected and modified, or insurance has not responded to the initial claim. Balance Control is used to flag one or more charges on an encounter to be rebilled to insurance. To flag all the charges to be rebilled, do the following: Open NextGen® Enterprise PM. Select Charges. The Charge Posting window opens. Select the desired patient and encounter, and then select the Balance Control icon. The Balance Control window opens. Right-click in the R (Release to Bill) column for the payer to be rebilled. Select Select All Ins. All line items show check mark in the R (Release to Bill) column, the encounter status changes to Rebill, and the Rebill Encounter check box is automatically selected. To save changes and close the window, select OK. To flag specific charges to be rebilled, do the following: Open the Balance C

Help Guide for NextGen® Enterprise PM 8

Set Up the Secondary and Tertiary Encounter Rate Tabs

The Secondary Encounter Rate and Tertiary Encounter Rate tabs on the Encounter Rate Billing Library Maintenance window contain billing rules that apply when the ER payer is the secondary or tertiary payer on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Secondary Encounter Rate or Tertiary Encounter Rate tab. Select the Secondary Calculations when Medicare is the primary payer or Tertiary Calculations when Medicare is the primary payer settings for calculating the encounter rate when Medicare is the primary payer. The options are: Encounter Rate amount is equal to the: Select one of the following options to determine the calculation for the encounter rate of the secondary or tertiary payer when Medicare is the primary insurance. Encounter Rate minus Medicare allowed Medicare allowed minus Medicare paid Encounter Rate amount minus Medicare paid Medicare paid minus Encounter Rate amount Encounter Rate amoun

Rebill a Batch for Secondary Insurance

Recommendations

Bill Multiple Encounters (Batch Billing)

Billing Process Work Flow

Batch Status

Balance Control

Rebill an Encounter using Balance Control

Set Up the Secondary and Tertiary Encounter Rate Tabs

Bill Multiple Encounters (Batch Billing)

Billing Process Work Flow

Batch Status

Balance Control

Rebill an Encounter using Balance Control

Set Up the Secondary and Tertiary Encounter Rate Tabs