Set Up Enterprise Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Practice Preferences for Encounter Rate Billing

To use encounter rate billing in NextGen® Enterprise PM, specific options must be enabled for the practice in Practice Preferences. Enable Qualifying Encounter Billing Process Date for Encounter Rate SIM and Adjustments Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Add or Modify Departments for Encounter Rate Billing

Creating unique encounter rate departments for use in the SIM library with Encounter Rate (ER) SIM codes can assist with reporting in NextGen® Enterprise PM. Financial reports can be filtered to either include or exclude ER codes by department, and reports can be sorted by department to group ER codes together. If encounter rate billing is used for more than one payer, create a separate department for each payer’s encounter rate SIM code(s). For example: Medicare Enc Rate Medicaid Enc Rate To add or modify a department for encounter rate billing, do the following: Access File Maintenance. Select Master Lists. The Master Lists List window opens. In the Master List field, select Departments. The Departments List appears. Do one of the following: To add a department, select Open Menu and select New. To modify a department, select the department from the list, and then select Open Menu and select Open. The Add/Modify Department Information window opens. Add Department Information In the De

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounter Rate Billing

Encounter rate billing in NextGen® Enterprise PM involves the following setup in System Administrator and File Maintenance: Security Access Rights Enterprise Preferences Practice Preferences CPT4 Codes Revenue Codes Departments Service Items Library Claim Edits Library Transaction Codes Encounter Rate Billing Library Payers Set Up Security Access Rights for Encounter Rate Billing Set Up Enterprise Preferences for Encounter Rate Billing Practice Preferences for Encounter Rate Billing Add or Modify CPT4 Codes for Encounter Rate Billing Add or Modify Revenue Codes for Encounter Rate Billing Add or Modify Departments for Encounter Rate Billing Add or Modify SIM Codes for Encounter Rate Billing Set Up Claim Edits for Encounter Rate Billing Add or Modify Transaction Codes for Encounter Rate Billing Add or Modify an Encounter Rate Billing Library Set Up Payers for Encounter Rate Billing Parent topic: Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Enable Qualifying Encounter Billing

The Encounter Rate Billing functionality in NextGen® Enterprise PM includes logic that identifies multiple encounters for a patient on the same date of service at the same location with the same encounter rate payer. Qualifying Encounter Billing must be enabled for the practice. When enabled, the Encounter Rate Billing Status fields display on the Billing & Collections tab of the Encounter Maintenance window. These fields are used to determine which encounter to bill when a patient has multiple same-day encounters with more than one provider at the same location with the same encounter rate payer attached. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Practice. The Practice Preferences window opens. From the Preference List, select Claims. Select the Enable Qualifying Encounter Billing check box. To save changes and close the window, select OK. Parent topic: Practice Preferences for Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Configure Encounter Types in NextGen® Enterprise EHR User Preferences

Encounters created in NextGen® Enterprise PM have an encounter type of Billable and can be seen by users in NextGen® Enterprise PM. Encounters created in NextGen® Optical Management have an encounter type of Optical/Billable and can be seen by users in NextGen® Optical Management and NextGen® Enterprise PM. Encounters created in NextGen® Enterprise EHR have an encounter type of Clinical and can be seen by users in NextGen® Enterprise EHR. Because Billable and Optical encounters are not typically seen in NextGen® Enterprise EHR, users have the ability to enable options in their user preferences so those encounters can be seen in NextGen® Enterprise EHR. Log on NextGen® Enterprise EHR. From the Tools menu, select Preferences. The Preferences window appears. Select the Main Toolbar tab. In the Patient Encounters section of the window, select one or both of the following Filter options: Billable Encounters: Select this check box to show billable encounters in NextGen® Enterprise EHR. Note:

Set Up Enterprise Preferences for Encounter Rate Billing

Recommendations

Set Up Payers for Encounter Rate Billing

Practice Preferences for Encounter Rate Billing

Add or Modify Departments for Encounter Rate Billing

Setting Up Encounter Rate Billing

Enable Qualifying Encounter Billing

Configure Encounter Types in NextGen® Enterprise EHR User Preferences