Set Up the Primary Encounter Rate Tab

Help Guide for NextGen® Enterprise PM 8

Set Up the Secondary and Tertiary Encounter Rate Tabs

The Secondary Encounter Rate and Tertiary Encounter Rate tabs on the Encounter Rate Billing Library Maintenance window contain billing rules that apply when the ER payer is the secondary or tertiary payer on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Secondary Encounter Rate or Tertiary Encounter Rate tab. Select the Secondary Calculations when Medicare is the primary payer or Tertiary Calculations when Medicare is the primary payer settings for calculating the encounter rate when Medicare is the primary payer. The options are: Encounter Rate amount is equal to the: Select one of the following options to determine the calculation for the encounter rate of the secondary or tertiary payer when Medicare is the primary insurance. Encounter Rate minus Medicare allowed Medicare allowed minus Medicare paid Encounter Rate amount minus Medicare paid Medicare paid minus Encounter Rate amount Encounter Rate amoun

Help Guide for NextGen® Enterprise PM 8

Set Up the Claims Tab

The Claims tab on the Encounter Rate Billing Library Maintenance window contains a series of questions designed for configuring claims for the ER payer. Primary, secondary and tertiary claims for the payer can be configured separately. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Claims tab. Existing Claim Detail Rules sets display as separate rows, with the current active row at the top of the list. Rows can be sorted by selecting on the Eff Date, Exp Date or Description column headings. Do one of the following: To add a Claim Detail Rules set, select open menu button and select New. To modify a Claim Detail Rules set, select the row from the list, and then select open menu button and select Open. To copy a Claim Detail Rules set, select the row from the list, and select open menu button and select Copy. The Encounter Rate Claim Detail Rules window opens. In the Effective Date and Expiration Date fields, enter an effe

Help Guide for NextGen® Enterprise PM 8

Set Up the General Tab

The General tab on the Encounter Rate Billing Library Maintenance window contains rules that apply when the ER payer is the primary, secondary, or tertiary payer on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. On the General tab, set the general billing rule options as needed. Set the Encounter Rate Exempt setting. This setting applies only when one or more of the charge line SIM codes is flagged as Enc rate exempt in the Service Items library. The options are: Disqualify patient encounter from ER billing if: Select one of the following options to set the basis for disqualifying an encounter from encounter rate billing: All SIMs are ER exempt Only one SIM is ER exempt Suppress claim for disqualified patient encounter: Select this option to suppress the claim for any encounter that is disqualified from encounter rate billing based on exempt SIM codes. Select a Multiple Patient Encounters per day setting. This settin

Help Guide for NextGen® Enterprise PM 8

Set Up Encounter Rate SIM Maintenance Configurations

After you set the SIM configuration hierarchy, you must set up specific parameters for the encounter rate SIM code. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Select a library from the list. The Encounter Rate Billing Library Maintenance window opens. Right-click the Encounter Rate SIM grid, and then select New. The Encounter Rate SIM Maintenance window opens. Encounter Rate SIM Maintenance window Enter the service item number. Select the effective and expiration dates. Enter the co-pay amount. Select a condition code for Field Locator 18 on UB claims. Note: The Description and Amount fields are automatically filled in based on the service item description for the encounter and the corresponding dollar value from the SIM. You can modify the values. Optional: In the Required CPT4 section, select the open record button, and then select the codes. Select the payer in COB. Optional: In the Valid Primary Payers section, se

File Maintenance Help for NextGen® Enterprise 8

Set Up the Primary Encounter Rate Tab

The Primary Encounter Rate tab on the Encounter Rate Billing Library Maintenance window contains billing rules that apply when the ER payer is the primary on the encounter. Open the Encounter Rate Billing library. The Encounter Rate Billing Library Maintenance window opens. Select the Primary Encounter Rate tab. Set the Suppress Claim Creation setting. The option is: Suppress claim for multiple same-day encounters (Multi-Yes only): Select this option to suppress the creation of a claim for an encounter with a status of Multi-no if there are multiple encounters per day. Set the Encounter Rate Calculation setting. The option is: Add 20% of original charge line items to encounter rate amount: Select this option to calculate 20% of the original charge amounts and add that to the encounter rate amount before inserting the new charge on the encounter. Set the Auto Adjustments settings. These settings have no impact on alternate payer charge lines. The option is: Adjust remaining balance of c

Help Guide for NextGen® Enterprise PM 8

Set Up the Primary Encounter Rate Billing Options

Open File Maintenance. Select Libraries > Encounter Rate Billing.The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button , and then select Open. The Encounter Rate Billing Library Maintenance window opens. Select the Primary Encounter Rate tab. In the Suppress Claim Creation setting, select the Suppress claim for multiple same-day encounters (Multi-Yes only) option to suppress the creation of a claim for an encounter with a status of Multi-no if there are multiple encounters in a day. In the Encounter Rate Calculation setting, select the Add 20% of original charge line items to encounter rate amount option to calculate 20% of the original charge amounts and add it to the encounter rate amount before inserting the new charge on the encounter. Set the Auto Adjustments settings to one of the following. These settings have no i

Set Up the Primary Encounter Rate Tab

Recommendations

Set Up the Secondary and Tertiary Encounter Rate Tabs

Set Up the Claims Tab

Set Up the General Tab

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the Primary Encounter Rate Tab

Set Up the Primary Encounter Rate Billing Options

Set Up the Primary Encounter Rate Tab

Set Up the Secondary and Tertiary Encounter Rate Tabs

Set Up the Claims Tab

Set Up the General Tab

Set Up Encounter Rate SIM Maintenance Configurations

Set Up the Primary Encounter Rate Tab

Set Up the Primary Encounter Rate Billing Options