Recalculation Results Report

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

System Administrator Help

Encounters Operation

Subgroup Used in Description Add Patient Encounter NextGen® Enterprise PM & NextGen® Enterprise EHR Enables users to create encounters. Convert In Progress Batch Process NextGen® Enterprise PM Enables users to change the status of multiple encounters from "In Progress" to "Unbilled". Convert In Progress Demand Process NextGen® Enterprise PM Enables users to change the status of an encounter from "In Progress" to "Unbilled". Convert In Progress Indicator NextGen® Enterprise PM &NextGen® Enterprise EHR Enables users to modify (select or clear) the Convert In Progress check box on the Encounter Maintenance window. Delete Encounter Rate SIM and Rate NextGen® Enterprise PM Enables users to delete an encounter rate SIM and encounter rate amount from Encounter Maintenance. Delete Patient Encounter NextGen® Enterprise PM &NextGen® Enterprise EHR Enables users to delete patient encounters. Demand Bill NextGen® Enterprise PM Enables users to access the Bill toolbar button or right-click menu to

Help Guide for NextGen® Enterprise PM 8

Retrieving Charge Amount in Cost Estimation

Charge amount is the amount a healthcare provider sets for the rendering services before applying any discounts. The pricing for a service depends on whether the place of service is a facility or non-facility location. If you are the administrator, you can set the Non-Facility Price and Facility Price fields for a specific SIM code in the SIM library and SIM exception. For information on setting up the pricing for a service item in File Maintenance, go to the NextGen Healthcare Success Community and download the File Maintenance Libraries Guide forNextGen®Enterprise. When you estimate the patient cost, the value for the charge amount is returned as follows: If the charge amount is set in the SIM exception and SIM library, the value in the SIM exception returns. If the charge amount is set in the SIM exception only, the value in the SIM exception returns. If the charge amount is set in the SIM library only, the value in the SIM library returns. If the charge amount is not set in the SIM

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from Encounter Lookup

Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. In the Bill Status field, select Rebill or 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 encounter. Select Find. Encounters matching the search criteria display in the Encounter List section of the window. Select Encounter List, and then select the encounter to be billed in the Enc Nbr column. Right-click the encounter, and then select Bill. If the encounter is a self-pay encounter with no insurance attached, a message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The en

Help Guide for NextGen® Enterprise PM 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

File Maintenance Help for NextGen® Enterprise 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

Recalculation Results Report

Recommendations

Rebill an Encounter using Balance Control

Encounters Operation

Retrieving Charge Amount in Cost Estimation

Bill an Individual Encounter from Encounter Lookup

Charge Options Field Descriptions

Charge Options Field Descriptions

Rebill an Encounter using Balance Control

Encounters Operation

Retrieving Charge Amount in Cost Estimation

Bill an Individual Encounter from Encounter Lookup

Charge Options Field Descriptions

Charge Options Field Descriptions