NextGen Knowledge Center

Set Up SIM Options for OB Anesthesia Billing

To accommodate OB epidural billing needs, the Anesthesia Library > SIM Options tab includes a number of settings that may be helpful.

  1. Access File Maintenance.
  2. Select Libraries, and then Anesthesia.
    The Anesthesia Library List window opens.
  3. Double-click to open the desired library.
    The Anesthesia Library Maintenance window opens.
  4. In the Concurrency and Claim Rules section, do one of the following:
    • To create a new rule, select the Open Menu button and select New.

      The Anesthesia Library Payer Maintenance window opens.

      For more information, see Set Up Concurrency and Claim Rules for Anesthesia Billing

    • To modify an existing rule, select the row from the list, select the Open Menu button and select Open.

      The Anesthesia Library Payer Maintenance window opens.

  5. Select the SIM Options tab.

  6. In the Service Items Range Options section, do one of the following:
    • To create a new SIM range, select the Open Menu button and select New.

      The SIM Range window opens.

      For more information, see Set Up SIM Options for Anesthesia Billing.

    • To modify an existing SIM range, select a SIM From / SIM To range.
  7. Refer to the following table for options intended for use with OB Anesthesia Billing.
    FieldDescription
    Exempt from Concurrency

    Select this check box to exclude the selected SIM range from being counted against max concurrency (not a concurrent case) for the selected payers.

    During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the SIM is ignored during calculation of concurrent charges for MDA/CRNA. The SIM does not split during the conversion process and is billed without medical direction modifiers.

    Anesthesia Minutes per Unit:
    Minutes per Timespan

    From/Thru

    Select this button when a payer has different minutes per unit rules for a specified time frame. For example, a payer may permit billing of 4 units per hour for the first hour (1 unit = 15 minutes) but only 1 unit per hour for subsequent hours (1 hour = 60 minutes).

    Up to three From/Thru ranges can be entered with different Minutes per Unit. The From 1 value defaults to 0 and the Thru 1 value defaults to a maximum of 9999. When a From 2 value is entered, the Thru 1 value updates accordingly and the Thru 2 value defaults to 9999. When a From 3 value is entered, the Thru 2 value updates accordingly and the Thru 3 value defaults to 9999. This eliminates any potential gaps in time.

    Minutes per Unit may also be defined in other areas. When an anesthesia charge is entered, the following hierarchy (highest to lowest) is used to determine the Minutes per Unit for the charge:
    • Minutes Per Timespan for SIM range on the SIM Options tab of the Anesthesia library
    • Minutes Per Unit for SIM range on the SIM Options tab of the Anesthesia library
    • Minutes Per Unit on the Concurrency Rules tab of the Anesthesia library
    • Anesthesia Minutes per Unit on the Defaults-2 tab of the Payers master file
    Total Time Units

    Minimum/Maximum

    		Enter minimum and maximum unit values for payers that have rules for the selected SIM range defining the minimum and/or maximum number of time units that are allowed to be billed.

    During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the total time units must fall within the minimum/maximum range defined here. If the total time units are less than the defined minimum, the defined minimum is used to calculate the extended price. If the total time units are greater than the defined maximum, the defined maximum is used to calculate the extended price.

    Base Units + Time Units + Modifier Units = Total Anesthesia Units

    Anesthesia SIM Price:

    Total Price

    Minimum/Maximum

    		Enter minimum and maximum dollar amounts for payers that have rules for the selected SIM range defining the minimum and/or maximum price that is allowed to be billed.

    During the Anesthesia Concurrency Audit process in NextGen® Enterprise PM, the total calculated price for all anesthesia charges on the encounter must fall within the minimum/maximum price.

    If the total calculated price for the encounter is less than the defined minimum price, the defined minimum price is used as the extended price for the SIM and distributed across charge lines with weighted distribution based on price.

    If the total calculated price for the encounter is greater than the defined maximum price, the defined maximum price is used as the extended price for the SIM and distributed across charge lines with weighted distribution based on price.