Set Up Payers for Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

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

To set up a SIM code for roll-up billing by revenue 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

Help Guide for NextGen® Enterprise PM 8

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

Roll-Up Billing by Revenue 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 Revenue Code Roll Up check box on the Payer tab in the SIM Library. 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 Revenue Code

Help Guide for NextGen® Enterprise PM 8

Set Up Revenue Codes for Roll-Up Billing

Roll-up payers that are billed on UB/837I claims require a four-digit Revenue Code in Field Locator 42 for each line item on the claim. Therefore, a Revenue Code must be attached to all SIM codes in the Service Items Library that may be billed on a UB/837I claim. Note: The Revenue Codes master file in File Maintenance is pre-installed. Items should be reviewed and modified as needed. To set up a revenue code for roll-up billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Revenue Codes. The Revenue Codes List window opens. Do one of the following: To add a revenue code, select Open Menu and select New. To modify a revenue code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Revenue Code Informationwindow opens. Add Revenue Code Information In the Code field, enter the four-digit revenue code. This field is required. In the Description field, enter a descriptive name for the revenue code. This field i

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

Setting Up Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code in NextGen® Enterprise PM involves the following setup in File Maintenance: Practice Preferences Revenue Codes General and Payer tabs in Service Items library Payers Set Up Practice Preferences for Roll-Up Billing by Revenue Code Set Up Revenue Codes for Roll-Up Billing Set Up SIM Codes for Roll-Up Billing by Revenue Code Set Up Payers for Roll-Up Billing by Revenue Code Parent topic: Roll-Up Billing by Revenue Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue 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 revenue code. This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item. Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC 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 this setup, all SIM codes on an encounter with the same revenue 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-u

Set Up Payers for Roll-Up Billing by Revenue Code

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

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Setting Up Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code

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

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

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Setting Up Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code