Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Encounter Rate Billing in NextGen® Enterprise PM

This section provides information about specific functionality in NextGen® Enterprise PM related to encounter rate billing. Encounter Rate Billing Status Encounter Rate SIM Codes Encounter Rate SIM Narrative for Claims Reverse Encounter Rate Adjustments Parent topic: Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Enterprise Preferences for Encounter Rate Billing

You must enable encounter rate billing for the enterprise. When enabled, further setup can be completed for practices within the enterprise that use encounter rate billing functionality. This also enables an Encounter Rate Billing library to be attached to the appropriate payers later in the setup. Access NextGen® Enterprise PM. From the Admin menu, select Preferences, and then Enterprise. The Enterprise Preferences window appears. Select the General tab. Select the Encounter rate billing check box. Enterprise Preferences To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Practice Preferences for Encounter Rate Billing

To use encounter rate billing in NextGen® Enterprise PM, specific options must be enabled for the practice in Practice Preferences. Enable Qualifying Encounter Billing Process Date for Encounter Rate SIM and Adjustments Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Encounter Rate Billing Library

The Encounter Rate Billing library enables you to configure the billing process for payers who require a flat encounter rate. This library is used to configure the business rules applicable to a payer. The Encounter Rate Billing library provide the flexibility to set up multiple rate codes to accommodate the different billing requirements of individual payers. The appropriate library can then be attached to the payer. A SIM with the appropriate CPT4 code must be set up in the SIM library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing library, the SIM Configuration Hierarchy and the encounter rate information are also copied. To add or modify an Encounter Rate Billing library, do the following: Access File Maintenance. Select Libraries, and then Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select Open Menu and select New. To modify a library, select the library from the list, and

Help Guide for NextGen® Enterprise PM 8

Add or Modify Departments for Encounter Rate Billing

Creating unique encounter rate departments for use in the SIM library with Encounter Rate (ER) SIM codes can assist with reporting in NextGen® Enterprise PM. Financial reports can be filtered to either include or exclude ER codes by department, and reports can be sorted by department to group ER codes together. If encounter rate billing is used for more than one payer, create a separate department for each payer’s encounter rate SIM code(s). For example: Medicare Enc Rate Medicaid Enc Rate To add or modify a department for encounter rate billing, do the following: Access File Maintenance. Select Master Lists. The Master Lists List window opens. In the Master List field, select Departments. The Departments List appears. Do one of the following: To add a department, select Open Menu and select New. To modify a department, select the department from the list, and then select Open Menu and select Open. The Add/Modify Department Information window opens. Add Department Information In the De

Setting Up Encounter Rate Billing

Recommendations

Encounter Rate Billing in NextGen® Enterprise PM

Set Up Payers for Encounter Rate Billing

Set Up Enterprise Preferences for Encounter Rate Billing

Practice Preferences for Encounter Rate Billing

Add or Modify an Encounter Rate Billing Library

Add or Modify Departments for Encounter Rate Billing

Setting Up Encounter Rate Billing

Encounter Rate Billing in NextGen® Enterprise PM

Set Up Payers for Encounter Rate Billing

Set Up Enterprise Preferences for Encounter Rate Billing

Practice Preferences for Encounter Rate Billing

Add or Modify an Encounter Rate Billing Library

Add or Modify Departments for Encounter Rate Billing