Medical Direction for Anesthesia Billing

Help Guide for NextGen® Enterprise PM 8

Provider Specialty Mappings for Anesthesia Billing

In NextGen® Enterprise PM, you can select the specialties for Medical Directors, CRNAs, and AAs. MD Anesthesia: This field appears on the Encounter Maintenance > General tab and is limited to a list of Medical Directors. This allows you to select an encounter-level Medical Director. MD Anesth: This field appears on the Charge Posting window and is limited to a list of Medical Directors. This allows you to select a charge-level Medical Director. Anesthesia Provider: This field appears on the Encounter Lookup window and is limited to a list of Medical Directors, CRNAs and AAs. This allows you to select one or more anesthesia providers for encounter lookup. Note: The Anesthesia library must be selected in Practice Preferences > Libraries in order for the above fields to appear in NextGen Enterprise PM. Parent topic: Add or Modify an Anesthesia Library

Help Guide for NextGen® Enterprise PM 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 in the Medical Director and CRNA. After the charges are split, units are only used for reporting purposes. Note: The total charge calculation is the same for split billing and non-split billing. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. Select Concurrency Rules. Enter the Concurrency Rules parameters

Help Guide for NextGen® Enterprise PM 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

File Maintenance Help for NextGen® Enterprise 8

Medical Direction for Anesthesia Billing

The Medical Direction tab on the Anesthesia Library Payer Maintenance window enables you to assign concurrency modifiers and documentation modifiers required by payers that indicate the level of medical direction. The modifiers assigned to each level of concurrency (1 case, 2-4 cases, 5+ cases) determine whether charges are split between Medical Directors and CRNAs during the Anesthesia Concurrency Audit process in NextGen Enterprise PM. Non-Split Charges: Charges are not split for the level of concurrency when either of the following applies: A modifier is assigned to either the Medical Director or the CRNA, but not both. A modifier is not assigned to either the Medical Director or the CRNA. Both fields are blank. Split Charges: Charges are split for the level of concurrency when a modifier is assigned to both the Medical Director and the CRNA. Split charge calculations are based on the modifiers for each of the different levels of service. Note: Each level of Medical Direction can be

Help Guide for NextGen® Enterprise PM 8

Set Up Medical Direction for Anesthesia Billing

Setting up medical direction in anesthesia billing ensures proper supervision and compliance with regulatory standards, particularly for Medicare and other insurance billing. You can assign concurrency modifiers and documentation modifiers in the Medical Direction. In NextGen® Enterprise PM, the modifiers assigned to each level of concurrency 1 case, 2-4 cases, and 5+ cases determine whether charges are split between Medical Director and CRNA during the Anesthesia Concurrency Audit process. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. In Anesthesia Library Payer Maintenance, select Medical Direction. In Medical Direction, enter the concurrency modifiers, and medical direction of 1, 2-4, and 5+ cases. Select OK. Medical Direction Field Descriptions You can set up the medical direction for anesthesia billing. Parent topic: Medical Direction for Anesthesia Billing

File Maintenance Help for NextGen® Enterprise

Set Up Medical Direction for Anesthesia Billing

Setting up medical direction in anesthesia billing ensures proper supervision and compliance with regulatory standards, particularly for Medicare and other insurance billing. You can assign concurrency modifiers and documentation modifiers in the Medical Direction. In NextGen® Enterprise PM, the modifiers assigned to each level of concurrency 1 case, 2-4 cases, and 5+ cases determine whether charges are split between Medical Director and CRNA during the Anesthesia Concurrency Audit process. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. In Anesthesia Library Payer Maintenance, select Medical Direction. In Medical Direction, enter the concurrency modifiers, and medical direction of 1, 2-4, and 5+ cases. Select OK. Medical Direction Field Descriptions You can set up the medical direction for anesthesia billing. Parent topic: Add or Modify an Anesthesia Library

Medical Direction for Anesthesia Billing

Recommendations

Provider Specialty Mappings for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Medical Direction for Anesthesia Billing

Set Up Medical Direction for Anesthesia Billing

Set Up Medical Direction for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Medical Direction for Anesthesia Billing

Set Up Medical Direction for Anesthesia Billing

Set Up Medical Direction for Anesthesia Billing