Set Up CPT4 Codes for Roll-Up Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code requires specific settings in the Payers master file. Each payer that is to roll-up to a single CPT4 code line on the claim must have the CPT on Rev Code Roll-up option selected so that the CPT4 code appears in Field Locator 44 on UB claims. Also, the Ignore modifiers on roll-up option must be selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. Do one of the following: To add a payer, select Open Menu and select New. To modify a payer, select the payer from the list, and then select Open Menu and select Open. The Add/Modify Payer Information window opens. Select the Defaults-2 tab. Select the CPT on Rev Code Roll-up check box. Add Payer Information Select the Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. To

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

To set up a SIM code for roll-up billing by CPT4 code, do the following: Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. Do one of the following: To add a SIM code, select Open Menu and select New. To modify a SIM code, search for the code and then select the code from the list on the left. Select the General tab. Each SIM code that is to roll-up to a single line item on the claim must have the following parameters defined. Revenue Code: Select the appropriate revenue code for UB/837I claims. This is the default revenue code for all UB payers. If the roll-up payer requires a different revenue code, the Alt Rev code must be defined on the Payer tab for the roll-up payer. Form: Select 1500. This is the default type of form for all payers. If the roll-up payer requires a different form (e.g. UB), additional se

Help Guide for NextGen® Enterprise PM 8

Set Up Practice Preferences for Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 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 CPT4 Code Roll Up check box in the SIM library on the Payer tab. 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 CPT4 Code

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

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

Attach CPT4 Codes to Field Locator 51

In File Maintenance, select Master Files - System and then Payers. Select the payer from the Payers List window. The Add/Modify Payer Information window opens. Select the Practice Parameters tab and then UB tab. Select the Open Menu button at the bottom of the window and select New. The Field Loc 51 for a CPT4 Range window opens. Enter the CPT4 code you want to attach to the provider in the CPT4 field. If you want to enter a range of CPT4 codes, your entry in this field serves as the beginning of the range. This field is required. Note: Select the Question Mark icon to perform a CPT4 Code search. You can search by code or by description. To enter a range of CPT4 codes, enter a second CPT4 code in the Thru CPT4 field. Enter the provider number in the Field Locator 51 field. This field is required. Select OK. Parent topic: UB Claims

Set Up CPT4 Codes for Roll-Up Billing

Recommendations

Set Up Payers for Roll-Up Billing by CPT4 Code

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Set Up Practice Preferences for Roll-Up Billing by CPT4 Code

Setting Up Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code

Attach CPT4 Codes to Field Locator 51

Set Up Payers for Roll-Up Billing by CPT4 Code

Set Up SIM Codes for Roll-Up Billing by CPT4 Code

Set Up Practice Preferences for Roll-Up Billing by CPT4 Code

Setting Up Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 Code

Attach CPT4 Codes to Field Locator 51