Reverse Encounter Rate Adjustments

Help Guide for NextGen® Enterprise PM 8

Reverse Encounter Rate Adjustments

The Encounter Rate Reversal option enables you to quickly reverse automatic adjustments made by the Encounter Rate Billing library. The system uses the exact adjustment code that was used during the billing process to reverse the adjustments on the charges that were included in the encounter rate. The process is the same for all COBs. When this option is selected, the system: Reverses the most recent encounter rate adjustment. A message appears stating that ann Encounter Rate Adj Reversal is about to occur for (payer name), and this action will remove the ER SIM and ER amount from encounter maintenance. Logs the adjustment reversal, removal of the ER SIM, and removal of the ER amount as a significant event. You can access this option from the Patient Chart on the Encounters tab by right-clicking on the encounter and selecting Encounter Rate Reversal. Parent topic: Encounter Rate Billing in NextGen Enterprise PM

Help Guide for NextGen® Enterprise PM 8

Reverse Automatic Adjustments from the Patient Chart

You can reverse automatic adjustments made on charges in outdated contracts. These adjustments are made when the encounter meets any of the following criteria: Automatic adjustments from a contract have been applied to a charge. The allowed amount for the charge line-item has been updated in the contract for the time period of the encounter. The encounter has a status of unbilled, billed, rebilled, or history. The begin DOS for charge is during the effective time period of the CPT4 that is defined in the Fee Schedule tab of the contract. The user performing the reverse automatic adjustments has the proper security. Open NextGen® Enterprise PM. On the main toolbar, select Chart or Chart Lookup . The Patient Lookup window opens. In the Search Criteria section, enter the patient's information, and then select Find. Patient records that match the search criteria, appear in the Matching Records section. Select the patient, and then select Open. The Patient Chart window opens. Select the Enc

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. Modify Payer Information To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Payers for Encounter Rate Billing

Once the Encounter Rate Billing library has been created, it must be attached to the appropriate encounter rate payers. Attaching the Encounter Rate Billing library ensures that during the billing process in NextGen® Enterprise PM, the ER SIM code is inserted onto the encounter and the claim is configured correctly to meet the ER payer's specific requirements. Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payers List window opens. From the list, select an ER payer, and then select Open Menu and select Open. The Modify Payer Information window opens. Select the Practice tab, and then select the Libraries sub-tab. In the Encounter Rate Library field, select the Encounter Rate Billing library for the payer. To save changes and close the window, select OK. Parent topic: Setting Up Encounter Rate Billing

Help Guide for NextGen® Enterprise PM 8

Set Up the Primary Encounter Rate Billing Options

Open File Maintenance. Select Libraries > Encounter Rate Billing.The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button , and then select Open. The Encounter Rate Billing Library Maintenance window opens. Select the Primary Encounter Rate tab. In the Suppress Claim Creation setting, select the Suppress claim for multiple same-day encounters (Multi-Yes only) option to suppress the creation of a claim for an encounter with a status of Multi-no if there are multiple encounters in a day. In the Encounter Rate Calculation setting, select the Add 20% of original charge line items to encounter rate amount option to calculate 20% of the original charge amounts and add it to the encounter rate amount before inserting the new charge on the encounter. Set the Auto Adjustments settings to one of the following. These settings have no i

File Maintenance Help for NextGen® Enterprise

Add or Modify an Encounter Rate Billing Library

Before you begin A SIM with an appropriate CPT4 code must be set up in the SIM Library before you set up encounter rate billing. Note: When you copy an Encounter Rate Billing Library, the SIM configuration hierarchy and the encounter rate information are also copied. Encounter Rate Billing Library provides flexibility to set up multiple rate codes to accommodate different billing requirements of individual payers. You can generate both Encounter Rate Library Listing and Encounter Rate Library with Claim Detail Rules reports from the Encounter Rate Billing Library. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Open File Maintenance. Select Libraries > Encounter Rate Billing. The Encounter Rate Billing List window opens. Do one of the following: To add a library, select the open menu button and then select New. To modify a library, select the library from the list, select the open menu button and th

Reverse Encounter Rate Adjustments

Recommendations

Reverse Encounter Rate Adjustments

Reverse Automatic Adjustments from the Patient Chart

Set Up Payers for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Set Up the Primary Encounter Rate Billing Options

Add or Modify an Encounter Rate Billing Library

Reverse Encounter Rate Adjustments

Reverse Encounter Rate Adjustments

Reverse Automatic Adjustments from the Patient Chart

Set Up Payers for Encounter Rate Billing

Set Up Payers for Encounter Rate Billing

Set Up the Primary Encounter Rate Billing Options

Add or Modify an Encounter Rate Billing Library