Process Date for Encounter Rate SIM and Adjustments

Some payers, such as Medicare for a Federally Qualified Health Center (FQHC), require that an encounter rate SIM code, or payment code, be included on claims to describe the type of visit. For example, code G0466 on a Medicare claim indicates a new patient visit, and code G0467 indicates an established patient visit.

The Encounter Rate Billing library in File Maintenance can be setup for a payer to automatically insert the ER SIM code, or payment code as an additional charge line on encounters during the billing process in NextGen® Enterprise PM.

With this setup, there is the potential for an ER SIM charge inserted by the system to have a process date that is different from the process dates on the original charge lines. For example, the original charges on an encounter may have been entered and processed on 2/28/17, but the encounter was not billed until 3/2/17. In this scenario, the original charges have a process date in the February accounting period, and the ER SIM charge on the same encounter has a process date in the March accounting period.

In addition, the Encounter Rate Billing library for a payer may also be setup to automatically apply adjustments to charges during the billing process in NextGen® Enterprise PM. Using the same scenario described above, the charges on an encounter would have a process date in the February accounting period and the auto-adjustment transactions against those charges would have a process date in the March accounting period.