Exempt from Concurrency

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

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

Billing Two Anesthesia Codes in the Event of Emergency C-Section

In the case where a vaginal delivery is planned but an emergency C-Section is necessary, additional set up is not required. The system permits the use of multiple anesthesia SIMs on a single claim. Note: Be advised that this is the only time where it is acceptable to report more than one anesthesia code on a claim. The system is coded using the assumption that clients are aware of billing rules and that billing for multiple anesthesia codes for the same case is typically not permitted. Example The patient was seen by the anesthesiologist from 1:00am to 1:30am for an epidural then the case managed from 1:31am to 3:00am. At 3:00am, it was determined an emergency C-section was needed. The payer permits billing for both face time and non-face time. Charge Posting: SIM 01967FT entered for time in attendance. SIM 01967NFTB entered for time spent on managing the case. SIM 01968 entered for the emergency C-section. Electronic Claim: Both line items are reported on the electronic claim. Paper C

Help Guide for NextGen® Enterprise PM 8

Total Price Minimum/Maximum

Some payers may define minimum and/or maximum price values for anesthesia services. Example Anesthesia administered from 1:00pm to 8:00pm. The payer has defined the maximum price to be $2000.00. Anesthesia Library > SIM Options tab: A maximum price of $2000.00 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 (1:00pm to 8:00pm). The number of units is calculated as 28 (420 minutes = 28 units of 15 minute each). The price is calculated as $2800.00 (28 units X $100 per unit). Anesthesia Concurrency Audit: Upon passing the Anesthesia Concurrency Audit process, the system updates the price to $2000.00 to meet the maximum price setting defined in the Anesthesia library. The number of units remains the same. Parent topic: OB Epidural Billing

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

Exempt from Concurrency

To address the billing scenario where pain management epidurals should not be counted against maximum concurrency allowances, the Exempt from Concurrency option on the Anesthesia Library > SIM Options tab can be used. If the check box is selected, the SIM or SIM range does not count against the provider’s concurrency settings. Example: SIM code 01967 has been flagged as Exempt from Concurrency. When this service is performed, it does not count against the maximum concurrency value. Parent topic: OB Epidural Billing

Exempt from Concurrency

Recommendations

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

Billing Two Anesthesia Codes in the Event of Emergency C-Section

Total Price Minimum/Maximum

Billing First Hour and Subsequent Hours Differently

Exempt from Concurrency

Exempt from Concurrency

Set Up SIM Options for OB Anesthesia Billing

Total Time Units Minimum/Maximum

Billing Two Anesthesia Codes in the Event of Emergency C-Section

Total Price Minimum/Maximum

Billing First Hour and Subsequent Hours Differently

Exempt from Concurrency