Add or Modify Transaction Codes for Encounter Rate Billing

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

Help Guide for NextGen® Enterprise PM 8

Add or Modify Revenue Codes for Encounter Rate Billing

Encounter rate payers that are billed on UB/837I claims require a four-digit revenue code in Field Locator 42 for each line item on the claim. Therefore, a revenue code must be attached to all SIM codes in the Service Items library that may be billed on a UB/837I claim. Note: The Revenue Codes master file in File Maintenance is pre-installed. Items should be reviewed and modified as needed. To add or modify a revenue code for encounter rate billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Revenue Codes. The Revenue Codes List window opens. Do one of the following: To add a revenue code, select Open Menu and select New. To modify a revenue code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Revenue Code Information window opens. In the Code field, enter the four-digit revenue code. This field is required. In the Description field, enter a descriptive name for the revenue code. This field is requi

Help Guide for NextGen® Enterprise PM 8

Add or Modify CPT4 Codes for Encounter Rate Billing

Encounter rate billing involves the insertion of an Encounter Rate (ER) code onto the patient's encounter. The ER code can then be included on the claim to the payer. The ER code must first be created as a CPT4 code. Example ER Codes may include the following: Medicare FQHC: G0466, G0467, G0468, G0469, G0470 Medicare RHC: 0521 Clinic Service Medicaid: 0529 Clinic Service Medicaid Texas: T1015 Clinic Service Medi-Cal: 01 Primary, 02 Secondary, 03 Dental, 04 Optometry To add or modify a CPT4 code for encounter rate 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. Add CPT4 Code Information In the Code field, enter the CPT4 code. This field is requ

Help Guide for NextGen® Enterprise PM 8

Add or Modify Transaction Codes for Encounter Rate Billing

Transaction codes can be used in the Encounter Rate Billing library to auto-adjust charges for payers using encounter rate billing. Having unique transaction codes assists in differentiating encounter rate adjustments from other types of adjustments on the UDS report. It also assists in either including or excluding encounter rate adjustments on financial reports in NextGen® Enterprise PM. If encounter rate billing is used for more than one payer, create a separate transaction code for each payer. For example: Medicare Enc Rate Adjustment Medicaid Enc Rate Adjustment To add or modify a transaction code for encounter rate billing, do the following: Access File Maintenance. Select System Master Files, then PM, and then Transaction Codes. The Transaction Codes List window opens. Do one of the following: To add a transaction code, select Open Menu and select New. To modify a transaction code, select the code from the list, and then select Open Menu and select Open. The Add/Modify Transacti

Help Guide for NextGen® Enterprise PM 8

Setting Up Encounter Rate Billing

Encounter rate billing in NextGen® Enterprise PM involves the following setup in System Administrator and File Maintenance: Security Access Rights Enterprise Preferences Practice Preferences CPT4 Codes Revenue Codes Departments Service Items Library Claim Edits Library Transaction Codes Encounter Rate Billing Library Payers Set Up Security Access Rights for Encounter Rate Billing Set Up Enterprise Preferences for Encounter Rate Billing Practice Preferences for Encounter Rate Billing Add or Modify CPT4 Codes for Encounter Rate Billing Add or Modify Revenue Codes for Encounter Rate Billing Add or Modify Departments for Encounter Rate Billing Add or Modify SIM Codes for Encounter Rate Billing Set Up Claim Edits for Encounter Rate Billing Add or Modify Transaction Codes for Encounter Rate Billing Add or Modify an Encounter Rate Billing Library Set Up Payers for Encounter Rate Billing Parent topic: Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set up Transaction Codes for Charge Discounts

When Charge Discounts are enabled in Practice Preferences, Discount Criteria section becomes available in the setup of Transaction Codes. You can set up specific adjustment transaction codes that are used for calculating charge discounts. You can create separate transaction codes to differentiate discount adjustments entered from the Charge Posting window and from other types of adjustments entered from the Payment Entry window. To set up adjustment Transaction Codes for charge discounts, do the following: Open File Maintenance. Select System Master Files, and then PM. Select Transaction Codes. The Transaction Codes List window opens. Do one of the following: To add a new transaction code, select the Open Menu icon and select New. To modify an existing transaction code, select the transaction code from the list, select Open Menu and select Open. The Add Transaction Code Information window opens. Enter a descriptive name for the code in the Transaction Description field. This is a requi

Add or Modify Transaction Codes for Encounter Rate Billing

Recommendations

Add or Modify Departments for Encounter Rate Billing

Add or Modify Revenue Codes for Encounter Rate Billing

Add or Modify CPT4 Codes for Encounter Rate Billing

Add or Modify Transaction Codes for Encounter Rate Billing

Setting Up Encounter Rate Billing

Set up Transaction Codes for Charge Discounts

Add or Modify Transaction Codes for Encounter Rate Billing

Add or Modify Departments for Encounter Rate Billing

Add or Modify Revenue Codes for Encounter Rate Billing

Add or Modify CPT4 Codes for Encounter Rate Billing

Add or Modify Transaction Codes for Encounter Rate Billing

Setting Up Encounter Rate Billing

Set up Transaction Codes for Charge Discounts