Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue 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 revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC 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 this setup, all SIM codes on an encounter with the same revenue 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-u

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing

Roll-Up Billing is an option for payers such as Medicare (RHC only) and Medicaid that have very unique and specific billing and claim requirements, and that reimburse at a flat encounter rate. Roll-Up Billing provides the ability to roll-up multiple charges on an encounter into a single line item on the claim. The amount on that line item will equal the total sum of the rolled-up charges. The roll-up can be done by revenue code (for example, 0521) or by CPT4 Code (for example, T1015). Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, roll-up billing will not meet the billing and claim requirements for a payer (e.g. FQHC 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. The roll-up billing considerations are as follows: Claims are not config

Help Guide for NextGen® Enterprise PM 8

Example: Roll-Up Billing by CPT4 Code

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within the Payer tab on the Service Item library. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line Parent topic: Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code and Transactions

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within thePayertab on theService Itemslibrary. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line The payer remits a $90.00 payment on the 0521 CPT4/HCPCS code line item. Because the encounter does not include the 0521 line item, the payment must be posted manually against the original charges. Adjustments are also posted manually against the original charges so the appropriate balances

Help Guide for NextGen® Enterprise PM 8

Setting Up Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences CPT4 Codes General and Payer tabs in Service Items library Payers Set Up Practice Preferences for Roll-Up Billing by CPT4 Code Set Up CPT4 Codes for Roll-Up Billing Set Up SIM Codes for Roll-Up Billing by CPT4 Code Set Up Payers for Roll-Up Billing by CPT4 Code Parent topic: Roll-Up Billing by CPT4 Code

File Maintenance Help for NextGen® Enterprise 8

CPT4 Roll Up

A CPT4 roll up combines the total charges for SIMs using the same CPT4 code into a single charge. If you enter an alternate CPT4 code for a SIM designated to perform CPT4 roll up, the application combines the charges with the alternate CPT4 code. To combine the total charges from SIMs using different CPT4 codes, each SIM included in the roll up must be mapped to the same alternate CPT4 code. You can perform line item roll-ups in the following instances: The separate line item charges are totaled. The quantity of line item charges are "rolled up" to become a single charge. CPT4 roll up is used primarily by CHC (Community Health Clinic) clients. The CPT roll up takes multiple line items that are flagged and have the same CPT code or alternate CPT code and rolls them up into a single line item and changes the quantity to one – the total sum of the charges appears on the line item. Activate a CPT4 Roll Up Parent topic: Payer Tab - SIM Library

Roll-Up Billing by CPT4 Code

Recommendations

Roll-Up Billing by Revenue Code

Roll-Up Billing

Example: Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code and Transactions

Setting Up Roll-Up Billing by CPT4 Code

CPT4 Roll Up

Roll-Up Billing by Revenue Code

Roll-Up Billing

Example: Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code and Transactions

Setting Up Roll-Up Billing by CPT4 Code

CPT4 Roll Up