Set Up Concurrency Rules for Anesthesia Billing

Help Guide for NextGen® Enterprise PM 8

Set Up Concurrency and Claim Rules for Anesthesia Billing

The Concurrency and Claim Rules section of the Anesthesia Library Maintenance window enables you to define rules for the payers and self-pay. Each set of rules is defined with an effective and expiration date. The date of service and payer on an anesthesia charge determines which set of rules is applied during the anesthesia concurrency audit and billing processes in NextGen Enterprise PM. Open File Maintenance. Select Libraries, and then select Anesthesia. The Anesthesia Library List window opens. From the list, double-click to open the library. The Anesthesia Library Maintenance window opens. In Concurrency and Claim Rules, do one of the following: To create a new rule or row, select open menu , and then select New. To modify an existing rule or row, select open menu , and then select Open. The Anesthesia Library Payer Maintenance window opens. In Effective Date, enter the date the rule set becomes effective. In Expiration Date, enter the date the rule set expires. In Description, en

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

Set Up SIM Options for Anesthesia Billing

The SIM Options tab on the Anesthesia Library Payer Maintenance window allows override parameters to be defined for specific payers and SIM code ranges. Override options include; exempt from concurrency, minutes per unit, time units, price, and contractual adjustments. In File Maintenance, select Libraries, and then select Anesthesia. The Anesthesia Library Payer Maintenance window opens. On the Anesthesia Library Payer Maintenance window, select the SIM Options tab. Select Open Menu , and then select New. The SIM Range window opens. In the SIM and Thru SIM fields, enter the range of SIM codes, and then select OK. Define the SIM Options parameters for the SIM Range and Valid Payers. Select OK. Parent topic: Add or Modify an Anesthesia Library

File Maintenance Help for NextGen® Enterprise

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

File Maintenance Help for NextGen® Enterprise 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 entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

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 entered in the Medical Director and CRNA fields. After the charges are split, units are only used for reporting purposes. Units are not split, but remain whole on each charge line, effectively doubling the units. Note: The total charge calculation is the same for split billing and non-split billing. On the Anesthesia Library Payer Maintenance window, select the Concurrency Rules

Set Up Concurrency Rules for Anesthesia Billing

Recommendations

Set Up Concurrency and Claim Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency and Claim Rules for Anesthesia Billing

Medical Direction for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing