Set Up Medical Direction for Anesthesia Billing
On the
Anesthesia Library Payer Maintenance
window, select the
Medical Direction
tab.
Complete the
Medical Direction
settings as needed.
To save changes and close the window, select
OK
.
Medical Direction Field Descriptions
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Help Guide for NextGen® Enterprise PM 8
Medical Direction for Anesthesia Billing
The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be
File Maintenance Help for NextGen® Enterprise 8
Set Up Medical Direction for Anesthesia Billing
On the Anesthesia Library Payer Maintenance window, select the Medical Direction tab. Complete the Medical Direction settings as needed. To save changes and close the window, select OK. Medical Direction Field Descriptions Parent topic: Medical Direction for Anesthesia Billing
File Maintenance Help for NextGen® Enterprise 8
Anesthesia Library Reports
The following Anesthesia Library reports can be generated from File Maintenance. The Report columns display information related to specific areas of setup for each library. Anesthesia Library Listing: This report includes information defined in the top section of the Anesthesia Library Maintenance window. Anesthesia with Payer Detail: This report includes information defined on the Anesthesia Library Payer Maintenance window for the Medical Direction, Concurrency Rules, and Claim Options tabs. Anesthesia with SIM Options: This report includes information defined on the Anesthesia Library Payer Maintenance window for the SIM Options tab. Generate an Anesthesia Library Report Parent topic: File Maintenance Library Reports
File Maintenance Help for NextGen® Enterprise 8
Medical Direction for Anesthesia Billing
The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be
Help Guide for NextGen® Enterprise PM 8
Setting Up Basic Anesthesia Billing
Basic Anesthesia Billing in NextGen® Enterprise PM involves setup in the following areas in File Maintenance: Service Items Library Payers Master File Claim Modifiers Library Submitter Profiles Library (electronic claims) Claim Printing Library (paper claims) Practice Preferences Service Items for Anesthesia Billing Payers for Anesthesia Billing Claim Modifiers Library Submitter Profile Options for Anesthesia Billing Claim Printing Library Options for Anesthesia Billing Practice Preferences Options for Anesthesia Billing Parent topic: Basic Anesthesia Billing
Help Guide for NextGen® Enterprise PM 8
Provider Specialty Mappings for Anesthesia Billing
The Provider Specialty Mapping in the Anesthesia library are used to calculate medical direction when the Anesthesia Concurrency Audit process is run in NextGen Enterprise PM. In addition, the specialties selected for Medical Directors, CRNAs and AAs are used to limit the providers that are available for selection in the following fields in NextGen Enterprise PM: MD Anesthesia: This field appears on the Encounter Maintenance > General tab and is limited to a list of Medical Directors. This allows you to select an encounter-level Medical Director. MD Anesth: This field appears on the Charge Posting window and is limited to a list of Medical Directors. This allows you to select a charge-level Medical Director. Anesthesia Provider: This field appears on the Encounter Lookup window and is limited to a list of Medical Directors, CRNAs and AAs. This allows you to select one or more anesthesia providers for encounter lookup. Note: The Anesthesia library must be selected in Practice Preference
