Provider Specialty Mappings for Anesthesia Billing

Help Guide for NextGen® Enterprise PM 8

Medical Direction for Anesthesia Billing

You can assign concurrency modifiers and documentation modifiers in the Medical Direction tab in the Anesthesia Library Payer Maintenance window. 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 setup to perform differently. For example, claims can be set to sp

Help Guide for NextGen® Enterprise PM 8

Provider Specialty Mappings for Anesthesia Billing

The Provider Specialty Mapping in the Anesthesia library are used to calculate medical direction when the Anesthesia Concurrency Audit process is run in NextGen Enterprise PM. In addition, the specialties selected for Medical Directors, CRNAs and AAs are used to limit the providers that are available for selection in the following fields in NextGen Enterprise PM: 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 Preference

File Maintenance Help for NextGen® Enterprise 8

Provider Specialty Mappings for Anesthesia Billing

The Provider Specialty Mapping in the Anesthesia library are used to calculate medical direction when the Anesthesia Concurrency Audit process is run in NextGen Enterprise PM. In addition, the specialties selected for Medical Directors, CRNAs and AAs are used to limit the providers that are available for selection in the following fields in NextGen Enterprise PM: 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 Preference

Help Guide for NextGen® Enterprise PM 8

Add or Modify an Anesthesia Library

Adding and modifying the anesthesia library enables you to modify the codes, rules, templates, and configurations used in anesthesia billing, scheduling, and clinical workflows. The Anesthesia library enables you to define rules that apply to the payers, and self-pay. Each set of rules includes the following: Medical Direction: These rules determine whether modifiers are added to charges based on the level of medical direction and whether charges will be split between Medical Directors and CRNAs. Concurrency Rules: These rules define specific parameters, such as the maximum number of concurrent procedures allowed, whether a Medical Director can perform and direct at the same time, and split-charge percentages for Medical Directors and CRNAs. Claim Options: These rules define specific claim parameters, such as whether or not surgical procedure codes are included on claims, and how claims break by rendering provider. SIM Options: These rules define parameters for specific SIM codes, such

File Maintenance Help for NextGen® Enterprise

Add or Modify an Anesthesia Library

Adding and modifying the anesthesia library enables you to modify the codes, rules, templates, and configurations used in anesthesia billing, scheduling, and clinical workflows. The Anesthesia library enables you to define rules that apply to the payers, and self-pay. Each set of rules includes the following: Medical Direction: These rules determine whether modifiers are added to charges based on the level of medical direction and whether charges will be split between Medical Directors and CRNAs. Concurrency Rules: These rules define specific parameters, such as the maximum number of concurrent procedures allowed, whether a Medical Director can perform and direct at the same time, and split-charge percentages for Medical Directors and CRNAs. Claim Options: These rules define specific claim parameters, such as whether or not surgical procedure codes are included on claims, and how claims break by rendering provider. SIM Options: These rules define parameters for specific SIM codes, such

Help Guide for NextGen® Enterprise PM 8

Anesthesia Library

The Anesthesia library enables you to define rules that apply to specific payers, other payers, and self-pay. Each set of rules may include one or more of the following: Medical Direction: These rules determine whether modifiers are added to charges based on the level of medical direction and whether charges will split between Medical Directors and CRNAs. Concurrency Rules: These rules define specific parameters, such as the maximum number of concurrent procedures allowed, whether a Medical Director can perform and direct at the same time, and split-charge percentages for Medical Directors and CRNAs. Claim Options: These rules define specific claim parameters, such as whether or not surgical procedure codes are included on claims, and how claims break by rendering provider. SIM Options: These rules define parameters for specific SIM codes, such as anesthesia units per unit or timespan, total time units minimum and maximum, total price minimum and maximum, and contractual adjustments. T

Provider Specialty Mappings for Anesthesia Billing

Recommendations

Medical Direction for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Add or Modify an Anesthesia Library

Add or Modify an Anesthesia Library

Anesthesia Library

Medical Direction for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Provider Specialty Mappings for Anesthesia Billing

Add or Modify an Anesthesia Library

Add or Modify an Anesthesia Library

Anesthesia Library