Recurring UB Billing

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounters for UB Claims

The following list outlines the areas of the Encounter Maintenance window that are important to the setup of UB claims: On the General tab, complete the Service Location field. On the UB tab, access the following sub-tabs: Condition Codes, Occurrence Codes, and Value Codes. Encounter Maintenance Note: For Enhanced UB users, the automated UB claims process only applies to payers who are considered primary. The automating of the Type of Bill field, the Occurrence codes, and the Value codes, which are explained in the following sections, only occurs for primary payers who have the required criteria. UB/General Tab UB/Condition Codes Tab UB/Occurrence Codes Tab UB/Value Codes Tab Setting Up Practice Preferences for UB Claims Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

Recurring UB Billing

Recurring UB billing is a process that enables you to indicate a treatment plan by linking claims using onset date, discharge date, default value code, and occurrence codes. These values are then copied forward from one encounter to the next. Default value and occurrence codes, which are set up in the Revenue Codes master file, automatically post to the encounter during billing if recurring billing is enabled. For the interim and final claims in the series, the onset date, value codes, and occurrence codes can be copied forward from the initial encounter. Recurring billing is used for billing a series of visits for the following therapies: Physical therapy Speech therapy Occupational therapy Note: The application currently works only for the revenue codes that represent the above therapies. File Maintenance Settings Required for Recurring UB Billing Setting Up UB Claim Forms Encounter Settings Required for Recurring UB Billing Parent topic: UB Claims

Help Guide for NextGen® Enterprise PM 8

UB Claims

This section provides information about the process of setting up UB claims for a regular UB user and an enhanced UB user. The rules for setting up and billing UB claims are different for the two types of users. Therefore, as a user, you should fit into one of the following two categories, if your practice processes UB claims: A Regular UB user is a practice that does some, but not exclusive UB claims billing. For example, if your practice primarily does 1500 claims processing and a small percentage of UB claims, then you would be considered a Regular UB user. An Enhanced UB user is a doctor or multiple doctors at a specific practice location that exclusively does UB claims billing. For example, a clinical rehabilitation practice with specific doctors at separate locations for Physical Therapy, Occupational Therapy, and Speech Therapy that exclusively process UB claims at one location would be considered an Enhanced UB user. UB claims must be set up by entering configuration informatio

Help Guide for NextGen® Enterprise PM 8

File Maintenance Settings Required for Recurring UB Billing

To enable recurring UB billing, you must set up the following items in File Maintenance: Practice Preferences Payer master file Revenue Codes The SIM library Set Up Practice Preferences for Recurring UB Billing Set Up the Payer Master File for Recurring UB Billing Override Practice Preferences with the Payer Master File Set Up Revenue Codes Set Up Revenue Codes for SIMs Parent topic: Recurring UB Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Revenue Codes

Revenue Codes used for physical therapy, occupational therapy, and speech therapy must be set up in the Revenue Codes master file for recurring billing. In File Maintenance, select Master Files - System and then Revenue Codes. Select the open menu button and then select New or select a revenue code from the list. The Modify Revenue Code Information window opens. Enter the revenue code, in the Code field. Valid codes and descriptions for recurring billing are: 420-429 - Physical Therapy 430-439 - Occupational Therapy 440-449 - Speech Therapy Enter the description that corresponds with the revenue code, in the Description field. Select your default occurrence code in the Occurrence Code field. Valid codes are: 35, 44, and 45. Select your default value code in the Value Code field. Valid codes are: 50, 51, and 52. Select OK. Parent topic: File Maintenance Settings Required for Recurring UB Billing

Help Guide for NextGen® Enterprise PM 8

Set Up the Payer Master File for Recurring UB Billing

The Frequency of Bill field must be set up in the Payer Master file to trigger recurring UB billing. In File Maintenance, select Master Files - System > Payers. Select the applicable payer from the list, and then select the UB tab on the Practice tab. In the Modify Payer Information window, select the location in the Location field if your practice has multiple locations. When the location is entered, the remaining fields in the window display the data you have set up for the payer. Note: The location that you select must be the same location as shown on the encounter. Select the rendering providers in the Rendering Provider field. Leave the Frequency of Bill field blank or set to <none>. This field must be blank for recurring billing. Enter data in other fields, as applicable for the payer for enhanced UB billing. For setup information on enhanced UB billing, refer to Setting Up UB Claims for Enhanced UB Users. Select OK. Parent topic: File Maintenance Settings Required for Recurring

Recurring UB Billing

Recommendations

Setting Up Encounters for UB Claims

Recurring UB Billing

UB Claims

File Maintenance Settings Required for Recurring UB Billing

Set Up Revenue Codes

Set Up the Payer Master File for Recurring UB Billing

Recurring UB Billing

Setting Up Encounters for UB Claims

Recurring UB Billing

UB Claims

File Maintenance Settings Required for Recurring UB Billing

Set Up Revenue Codes

Set Up the Payer Master File for Recurring UB Billing