Setting Up Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Example: Roll-Up Billing by CPT4 Code

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within the Payer tab on the Service Item library. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line Parent topic: Roll-Up Billing by CPT4 Code

Help Guide for NextGen® Enterprise PM 8

Roll-Up Billing by CPT4 Code and Transactions

The following charges are entered on an example encounter: Charge Alt CPT4 Code Amount Preventive/Non-Preventive 99212 0521 $95.00 Non-Preventive 11301 0521 $150.00 Non-Preventive 76090 $200.00 Preventive Charge Posting When the encounter is billed, a UB/837I claim is created. The appearance of the claim is a result of parameters defined within thePayertab on theService Itemslibrary. Claim Line 1: Includes the CPT4/HCPCS code (0521). The total charge amount is equal to the sum of all services that rolled-up because they have the same Alternate CPT4 Code (0521). Claim Lines 2 - n: Other services are listed separately on the claim with their corresponding CPT4/HCPCS code and charge amount. Claims Line The payer remits a $90.00 payment on the 0521 CPT4/HCPCS code line item. Because the encounter does not include the 0521 line item, the payment must be posted manually against the original charges. Adjustments are also posted manually against the original charges so the appropriate balances

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 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

Roll-Up Billing by CPT4 Code

Roll-Up Billing by CPT4 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 CPT4 code. This option is rarely used. It could be used for any payer that requires multiple services to be rolled-up to a single CPT4 code line item on the claim. Note: Best practice is to use encounter rate billing for both Medicare and Medicaid. In some cases, roll-up by CPT4 code will not meet the billing and claim requirements for a payer (e.g. FQHC/RHC 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 the setup, all SIM codes on an encounter with the same Alternate CPT4 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-up charges. In order for ch

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

Setting Up Roll-Up Billing by CPT4 Code

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Example: Roll-Up Billing by CPT4 Code

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