Total Price Minimum/Maximum

Help Guide for NextGen® Enterprise PM 8

Total Time Units Minimum/Maximum

Some payers may define minimum and/or maximum time unit values for anesthesia services. Example 1 Anesthesia administered from 1:00am to 1:30am. The payer has defined the minimum number of time units as 4. Anesthesia Library > SIM Options tab: A Minimum Time Unit value of 4 has been defined in the Anesthesia Library > SIM Options tab for the specified SIM /SIM range. Charge Posting: The service item is entered and the time range is defined (1:00am to 1:30am). The number of time units is calculated as 2 (30 minutes = Two 15 minute units). Note: In this example, the base units for the SIM code is set to 0 to clearly demonstrate that the Total Time Units Minimum setting affects time units only, and not total units. Anesthesia Concurrency Audit: Upon passing the Anesthesia Concurrency Audit process, the system updates the number of time units to 4 to meet the minimum units setting defined in the Anesthesia library. The price is updated accordingly. Example 2 Anesthesia administered from 1:

Help Guide for NextGen® Enterprise PM 8

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. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Double-click to open the desired library. The Anesthesia Library Maintenance window opens. 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. Select the SIM Options tab. 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 Opti

Help Guide for NextGen® Enterprise PM 8

Billing First Hour and Subsequent Hours Differently

In cases where the payer requires different unit calculations for the first and subsequent hours, the Minutes per Timespan option should be used in the Anesthesia Library > SIM Options tab. Example Anesthesia was administered from 1:00am to 4:00am. The payer allows billing for the first hour in 15 minute increments (4 units per hour). For subsequent hours, a reduced rate of 60 minute increments (1 unit per hour) is permitted. Anesthesia Library > SIM Options tab: The Minutes per Timespan option has been selected for the applicable code/code range and the Minutes Per Unit setting for the first time span is set to 15 minutes. Since 15 minute units are permitted for the first hour only and subsequent hours must be billed in 60 minute increments, the From time on the second line is set to 61 minutes. This automatically changes the Thru time on the previous line from 9999 to a value of 60. Charge Posting: The service item is entered and the time range defined (1:00am to 4:00am). The number

Help Guide for NextGen® Enterprise PM 8

Billing Time in Attendance

To accommodate the scenario where a payer recognizes only time in attendance with the patient or permits standard billing for time in attendance and decreased billing for time not spent in attendance, multiple service items should be utilized. One service item represents the actual time spent with the patient and the other represents time spent managing the case where the provider was not actually face to face with the patient. Example 1 A patient is in labor 7 ½ hours. The provider spends 30 minutes with the patient administering an epidural. The other 7 hours are spent managing the case but the provider is not actually with the patient. The provider bills anesthesia services at $100 per unit. The payer allows billing for face-to-face time in 15 minute units and billing for the additional time at a reduced rate of 60 minute units. SIM CPT4 FEE Represents face-to-face time: 01967FT 01967 $100 Represents non-face time that is billable: 01967NFTB 01967 $100 Note: The same CPT must be use

Help Guide for NextGen® Enterprise PM 8

OB Epidural Billing

The American Society of Anesthesiologists Relative Value Guide lists the following methods as examples to determine professional charges for billing labor anesthesia services: Base units plus time reporting in minutes (insertion through delivery) subject to a reasonable cap. Base units plus one unit per hour for neuraxial anesthesia service management plus direct patient contact time, commonly referred to as Face Time. Incremental time-based fees (e.g. 0<2 hrs, 2-6 hrs, >6 hrs) Single or flat fee Since practices determine their own method for billing OB anesthesia services, NextGen® Enterprise PM can accommodate commonly used and known methods of billing OB anesthesia services. These include: Pain Management epidurals should not be counted against maximum concurrency. Billing for labor cases that changed from a planned vaginal delivery to an emergency C-section. This is the only time billing two anesthesia codes on a claim is permitted. Some payers recognize only time in attendance wit

File Maintenance Help for NextGen® Enterprise 8

Set Up Concurrency Rules for Anesthesia Billing

The Concurrency Rules tab on the Anesthesia Library Payer Maintenance window enables you to define parameters related to concurrency audit rules, charge split percentages, unit price, contractual adjustments, rounding method, and minutes per unit. For both split and non-split charges, the total charge amount is determined by multiplying the unit price by the total anesthesia units. Base Units + Time Units + Modifier Units = Total Anesthesia Units Total Anesthesia Units x Unit Price = Total Charge Amount For split charges the extended price is split across the two resulting charge lines based on the percentages entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

Total Price Minimum/Maximum

Example

Recommendations

Total Time Units Minimum/Maximum

Set Up SIM Options for OB Anesthesia Billing

Billing First Hour and Subsequent Hours Differently

Billing Time in Attendance

OB Epidural Billing

Set Up Concurrency Rules for Anesthesia Billing

Total Time Units Minimum/Maximum

Set Up SIM Options for OB Anesthesia Billing

Billing First Hour and Subsequent Hours Differently

Billing Time in Attendance

OB Epidural Billing

Set Up Concurrency Rules for Anesthesia Billing