Set Up SIM Options 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

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

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. SIM Options for Anesthesia Billing You can use the SIM options field's description while setting the anesthesia billing. Parent topic: Add or Modify an Anesthesia Library

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for OB Anesthesia Billing

To accommodate OB epidural billing needs, the Anesthesia Library > SIM Options tab includes a number of settings that may be helpful. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule, select the Open Menu button and select New. The Anesthesia Library Payer Maintenance window opens. For more information, see Set Up Concurrency and Claim Rules for Anesthesia Billing To modify an existing rule, select the row from the list, select the Open Menu button and select Open. The Anesthesia Library Payer Maintenance window opens. Select the SIM Options tab. In the Service Items Range Options section, do one of the following: To create a new SIM range, select the Open Menu button and select New. The SIM Range window opens. For more information, see Set Up SIM Opti

Help Guide for NextGen® Enterprise PM 8

Set Up SIM Options for OB Anesthesia Billing

To accommodate OB epidural billing needs, the Anesthesia Library > SIM Options tab includes a number of settings that may be helpful. Access File Maintenance. Select Libraries, and then Anesthesia. The Anesthesia Library List window opens. Double-click to open the desired library. The Anesthesia Library Maintenance window opens. In the Concurrency and Claim Rules section, do one of the following: To create a new rule, select the Open Menu button and select New. The Anesthesia Library Payer Maintenance window opens. For more information, see Set Up Concurrency and Claim Rules for Anesthesia Billing To modify an existing rule, select the row from the list, select the Open Menu button and select Open. The Anesthesia Library Payer Maintenance window opens. Select the SIM Options tab. In the Service Items Range Options section, do one of the following: To create a new SIM range, select the Open Menu button and select New. The SIM Range window opens. For more information, see Set Up SIM Opti

File Maintenance Help for NextGen® Enterprise

Anesthesia Library Reports

The following Anesthesia Library reports can be generated from File Maintenance. The Report columns display information related to specific areas of setup for each library. Anesthesia Library Listing: This report includes information defined in the top section of the Anesthesia Library Maintenance window. Anesthesia with Payer Detail: This report includes information defined on the Anesthesia Library Payer Maintenance window for the Medical Direction, Concurrency Rules, and Claim Options tabs. Anesthesia with SIM Options: This report includes information defined on the Anesthesia Library Payer Maintenance window for the SIM Options tab. Generate an Anesthesia Library Report Parent topic: File Maintenance Library Reports

Set Up SIM Options for Anesthesia Billing

Recommendations

Set Up Concurrency and Claim Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing

Set Up SIM Options for OB Anesthesia Billing

Set Up SIM Options for OB Anesthesia Billing

Anesthesia Library Reports

Set Up Concurrency and Claim Rules for Anesthesia Billing

Set Up Concurrency Rules for Anesthesia Billing

Set Up SIM Options for Anesthesia Billing

Set Up SIM Options for OB Anesthesia Billing

Set Up SIM Options for OB Anesthesia Billing

Anesthesia Library Reports