Set Up Anesthesia SIMs

Field	Description
Form	Select the 1500 or UB claim form type for the selected SIM. Note: Anesthesia billing is not supported for ADA claims in NextGen® Enterprise PM. If you select ADA in the Form field, both the Base Unit field and the Anesthesia SIM check box clear and become unavailable.
Anesthesia SIM	Select this check box to designate a SIM code as an anesthesia SIM.
Base Unit	The Base Unit field becomes enabled when the Anesthesia SIM check box is selected. The base unit is used for calculating the price for a SIM when it is designated and used as an anesthesia SIM. Place your cursor at the beginning of the line and enter the number of base units. One Base Unit is equal to the number of minutes entered in the Anesthesia Minutes Per Unit field on the Defaults - 2 tab in the Payers master file. For example, if you enter 3 base units on the SIM and the anesthesia minutes per unit setting is 15, then the base unit would be equal to 45 minutes. Base unit values are assigned each year by the American Society of Anesthesiologists (ASA) in the Relative Value Guide. This number represents the minimum number of units you can bill for a procedure before time units are added. Note: The base unit entered here defaults to the Base Unit field on the Charge Posting window when the anesthesia SIM is entered during charge entry. For more information about anesthesia billing, go to NextGen Healthcare Success Community and download the latest Anesthesia Billing Guide for NextGen® Enterprise PM.
Price	The price is the dollar amount per unit to charge for the procedure. To determine the total price, the application multiplies this number by the anesthesia units. (Anesthesia Units = Base Unit + Time Units)

File Maintenance Help for NextGen® Enterprise 8

Set Up a SIM Used as an Anesthesia and a Dental SIM

Service items can be set up and billed as anesthesia or dental SIM. They must be set up at the Payer level in the Service Item Library. Open a SIM in a Service Item Library. Select the General tab. Ensure that 1500 or UB is selected in the Form drop-down list. Enter the applicable base units, up to four digits, in the Base Unit field. Note: One base unit is equal to either 10 or 15 minutes depending on the Anesthesia Minutes Per Unit setting on the Payer Defaults - 2 tab of the Payer master file. Check the Anesthesia SIM check box and then select the Payer tab. Select the applicable dental payer from the Payer drop-down list. You must designate this payer as a dental payer on the Payer tab of the Service Item Library Maintenance window. See Payer tab for more information. Enter the applicable effective and expiration dates in the Eff and Exp fields. Select ADA from the Form drop-down list. Enter any additional information that is applicable. Select OK. Parent topic: Dental SIMs

Help Guide for NextGen® Enterprise PM 8

Single Base Unit Anesthesia Charge per Encounter

The Single base unit Anes. charge per encounter option in Practice Preferences > Charge Entry controls whether base units are saved on all anesthesia charge lines, or on the first charge line only. When this check box is selected, the base units are saved only on the first anesthesia charge line entered on the Charge Posting window for the encounter. When this check box is not selected, the base units are saved on each anesthesia charge line entered on the Charge Posting window for the encounter. Important: For Basic Anesthesia Billing, this option is not required and should only be enabled when needed. For Anesthesia Concurrency Billing, this option is required and must be enabled, in addition to selecting an Anesthesia library in Practice Preferences > Libraries. The total anesthesia units for a charge are calculated as follows: [Base Units + Time Units + Modifier Units = Total Units] Base Units are defined for the SIM code in the Service Items library. Time Units are calculated base

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for OB Anesthesia Billing

To accommodate OB epidural billing needs, the Anesthesia Library > SIM Options tab includes a number of settings that may be helpful. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule, select the Open Menu button and select New. The Anesthesia Library Payer Maintenance window opens. For more information, see Set Up Concurrency and Claim Rules for Anesthesia Billing To modify an existing rule, select the row from the list, select the Open Menu button and select Open. The Anesthesia Library Payer Maintenance window opens. Select the SIM Options tab. In the Service Items Range Options section, do one of the following: To create a new SIM range, select the Open Menu button and select New. The SIM Range window opens. For more information, see Set Up SIM Opti

Help Guide for NextGen® Enterprise PM 8

Total Time Units Minimum/Maximum

Some payers may define minimum and/or maximum time unit values for anesthesia services. Example 1 Anesthesia administered from 1:00am to 1:30am. The payer has defined the minimum number of time units as 4. Anesthesia Library > SIM Options tab: A Minimum Time Unit value of 4 has been defined in the Anesthesia Library > SIM Options tab for the specified SIM /SIM range. Charge Posting: The service item is entered and the time range is defined (1:00am to 1:30am). The number of time units is calculated as 2 (30 minutes = Two 15 minute units). Note: In this example, the base units for the SIM code is set to 0 to clearly demonstrate that the Total Time Units Minimum setting affects time units only, and not total units. Anesthesia Concurrency Audit: Upon passing the Anesthesia Concurrency Audit process, the system updates the number of time units to 4 to meet the minimum units setting defined in the Anesthesia library. The price is updated accordingly. Example 2 Anesthesia administered from 1:

File Maintenance Help for NextGen® Enterprise 8

Set Up SIM Options for Anesthesia Billing

The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments. On the Anesthesia Library Payer Maintenance window, select the SIM Options tab. Select Open Menu and select New. The SIM Range window opens. In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK. Select (highlight) the SIM range and use the following table to define SIM Options parameters for the selected SIM range and Valid Payers. To save changes and close the window, select OK. Field Description Exempt from Concurrency Select this check box to exclude the selected SIM range from being counted against max concurrency (not a concurrent case) for the selected payers. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the SIM is ignored during calculation of concurrent ch

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for Anesthesia Billing

The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments. On the Anesthesia Library Payer Maintenance window, select the SIM Options tab. Select Open Menu and select New. The SIM Range window opens. In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK. Select (highlight) the SIM range and use the following table to define SIM Options parameters for the selected SIM range and Valid Payers. To save changes and close the window, select OK. Field Description Exempt from Concurrency Select this check box to exclude the selected SIM range from being counted against max concurrency (not a concurrent case) for the selected payers. During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the SIM is ignored during calculation of concurrent ch

Set Up Anesthesia SIMs

Recommendations

Set Up a SIM Used as an Anesthesia and a Dental SIM

Single Base Unit Anesthesia Charge per Encounter

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

Set Up SIM Options for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing

Set Up a SIM Used as an Anesthesia and a Dental SIM

Single Base Unit Anesthesia Charge per Encounter

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

Set Up SIM Options for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing