Set Up Payers for Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Set Up CPT4 Codes for Roll-Up Billing

Verify that the appropriate CPT4 codes exist that are needed on UB claims in Field Locator 44 for the roll-up payer. The CPT4 codes are linked to SIM codes as the Alternate CPT4 in the SIM library. To set up a CPT4 code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then CPT4 Codes. The CPT4 Code Search window opens. Do one of the following: To add a CPT4 code, select Open Menu and select New. To modify a CPT4 code, search for the code, then select the code from the list, and then select Open Menu and select Open. The Add/Modify CPT4 Code Information window opens. In the Code field, enter the CPT4 code. This field is required. In the Description field, enter a descriptive name for the code. This field is required. In the Type of Service field, select Medical Care. To save changes and close the window, select OK. Add CPT4 Code Information Parent topic: Setting Up Roll-Up Billing by CPT4 Code

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

Set Up Payers for Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code requires a specific setting in the Payers master file. Each payer that is to roll-up to a single revenue code line on the claim must have the Ignore modifiers on roll-up option selected so that modifiers entered on charges are ignored for the roll-up. To set up a payer for roll-up billing by revenue 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 Practice tab, and then select the Other sub-tab. Select the Ignore modifiers on roll-up check box. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Roll-Up Billing by Revenue Code

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

Help Guide for NextGen® Enterprise PM 8

Do Not Sum Units for CPT4 Code

With Behavioral Health Billing, multiple charges on a single encounter that have the same CPT4 code, the same modifier(s), the same base minutes and the same unit price will roll-up (bundle) to a single line item on claims. The total units on the claim is calculated using the total time entered on all roll-up charges. The amount on the claim for the roll-up line item is calculated using the total units multiplied by the base price in the SIM Library. Do Not Sum Units for CPT4 Code is an option that will prevent multiple charges on an encounter with the same CPT4 code and modifiers from rolling-up (bundling) to a single line item on claims. The option is available at the Practice level, the Payer level, and the CPT4/Payer level. Note: This option should only be enabled if charge bundling should not occur for a Practice, a specific Payer, or a specific CPT4/payer combination. Practice Preferences > Claims: Select this check box to prevent multiple charges with the same CPT4 code and modi

Set Up Payers for Roll-Up Billing by CPT4 Code

Recommendations

Set Up CPT4 Codes for Roll-Up Billing

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

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

Set Up Payers for Roll-Up Billing by Revenue Code

Attach CPT4 Codes to Field Locator 51

Do Not Sum Units for CPT4 Code

Set Up CPT4 Codes for Roll-Up Billing

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

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

Set Up Payers for Roll-Up Billing by Revenue Code

Attach CPT4 Codes to Field Locator 51

Do Not Sum Units for CPT4 Code