Roll-Up Billing by Revenue Code

Roll-Up Billing by Revenue Code provides the ability to roll-up multiple charges on an encounter into one line item on the claim. Each line item represents a specific revenue code.

This setup could be used for Medicare at a Rural Health Center to create a claim where all non-preventive services are rolled-up to a single 0521 revenue code line item.

Important Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, Roll-Up by Revenue Code will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements.

With this setup, all SIM codes on an encounter with the same revenue code will roll-up to a single line item on a claim and the amount on that line item will equal the total sum of the rolled-up charges.

In order for charges to roll-up into one line on the claim, the following components must be the same for all charges:

• Date of Service
• Rendering Provider
• Location
• Place of Service
• Modifier (unless Ignore Modifiers on Roll-Up is selected for the payer)
• Revenue Code
• Do not sum Units for CPT4 Code on SIM Library > Payer tab
• Single Unit Revenue Code Roll Up on SIM Library > Payer tab