Roll-Up Billing by CPT4 Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific CPT4 code.
This option is rarely used. It could be used for any payer that requires multiple services to be rolled-up to a single CPT4 code line item on the claim.
Note: Best practice is to use encounter rate billing for both Medicare and Medicaid. In some cases, roll-up by CPT4 code will not meet the billing and claim requirements for a payer (e.g. FQHC/RHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements.
With the setup, all SIM codes on an encounter with the same Alternate CPT4 Code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-up charges.
In order for charges to roll-up into one line on the claim, the following components must be the same for all charges:
- Date of Service
- Rendering Provider
- Location
- Place of Service
- Do not sum Units for CPT4 Code on the Payer tab of the SIM Library
- Single Unit CPT4 Code Roll Up on the Payer tab of the SIM Library
- Alternate CPT4 on the Payer tab of the SIM Library
