Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code

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 ch

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 Revenue Code for Medicare (RHC)

The following charges are entered on an example Medicare (RHC) encounter: Charge Revenue Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 0403 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created for Medicare Part A that meets the specific billing requirements for an RHC. The appearance of the claim is a result of parameters defined within the Payer tab of the Service Item library. Claim Line 1: Includes the Revenue Code (0521) and no CPT4/HCPCS code. The total charge amount is equal to the sum of all non-preventive services that rolled-up because they have the same Revenue Code. Claim Lines 2 - n: Preventive services are listed separately on the claim with their corresponding Revenue Code, CPT4/HCPCS code, and charge amount. Claims Parent topic: Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code and Transactions

The following charges are entered on an example Medicare (RHC) encounter: Charge Revenue Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 0403 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created for Medicare Part A that meets the specific billing requirements for an RHC. The appearance of the claim is a result of parameters defined within thePayertab of theService Itemslibrary. Claim Line 1: Includes the Revenue Code (0521) and no CPT4/HCPCS code. The total charge amount is equal to the sum of all non-preventive services that rolled-up because they have the same revenue code. Claim Lines 2 - n: Preventive services are listed separately on the claim with their corresponding revenue code, CPT4/HCPCS code, and charge amount. Claims Medicare remits a $90.00 encounter rate payment on the 0521 revenue code line item. Because the encounter does not include the 0521 line item, the payment must

Help Guide for NextGen® Enterprise PM 8

Setting Up Roll-Up Billing by Revenue Code

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

Help Guide for NextGen® Enterprise PM 8

Set Up Practice Preferences for Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code requires specific settings in the SIM Library. In order to flag SIM codes for roll-up billing, the Enable Qualifying Encounter Billing option must be selected in Practice Preferences. This enables the Single Unit Revenue Code Roll Up check box on the Payer tab in the SIM Library. Note: This setting is also required for tracking qualifying encounters in NextGen® Enterprise PM. It enables the three Qualifying Encounter check boxes on the General tab in the SIM library. To enable Qualifying Encounter Billing for the practice, do the following: Access Practice Preferences. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Practice Preferences Parent topic: Setting Up Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code

Recommendations

Roll-Up Billing by CPT4 Code

Roll-Up Billing

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

Roll-Up Billing by Revenue Code and Transactions

Setting Up Roll-Up Billing by Revenue Code

Set Up Practice Preferences for Roll-Up Billing by Revenue Code

Roll-Up Billing by CPT4 Code

Roll-Up Billing

Example: Roll-Up Billing by Revenue Code for Medicare (RHC)

Roll-Up Billing by Revenue Code and Transactions

Setting Up Roll-Up Billing by Revenue Code

Set Up Practice Preferences for Roll-Up Billing by Revenue Code