Setting Up Anesthesia Concurrency Billing

Help Guide for NextGen® Enterprise PM 8

Setting Up Basic Anesthesia Billing

Basic Anesthesia Billing in NextGen® Enterprise PM involves setup in the following areas in File Maintenance: Service Items Library Payers Master File Claim Modifiers Library Submitter Profiles Library (electronic claims) Claim Printing Library (paper claims) Practice Preferences Service Items for Anesthesia Billing Payers for Anesthesia Billing Claim Modifiers Library Submitter Profile Options for Anesthesia Billing Claim Printing Library Options for Anesthesia Billing Practice Preferences Options for Anesthesia Billing Parent topic: Basic Anesthesia Billing

Help Guide for NextGen® Enterprise PM 8

Charge Posting for Anesthesia Billing

Once you have setup your practice to support anesthesia billing by completing the setup for anesthesia concurrency billing, and defined your claim rules and SIM pricing options in File Maintenance for anesthesia, you need to select a default practice-level Anesthesia Library and set up an ASA Crosswalk library to activate the crosswalk file on the Charge Posting window before entering charges for anesthesia services. Enter Anesthesia Charges You can enter anesthesia charges on the Charge Posting window. Anesthesia Service Information Window Parent topic: Anesthesia Concurrency Billing

Help Guide for NextGen® Enterprise PM 8

ASA Crosswalk Library

The ASA Crosswalk library enables you to create a table of cross-references between anesthesia CPT codes and surgical procedure CPT codes. When the crosswalk is activated for one or more locations within the practice, charges for those locations are entered on the Charge Posting window in NextGen® Enterprise PM using one of the following methods: An anesthesia code is entered in the Svc Item field, and then the corresponding surgery code is selected from the crosswalk in the Surg Proc field. A surgery code is entered in the Surg Proc field, and then the corresponding anesthesia code from the crosswalk automatically defaults into the Svc Item field. The ASA Crosswalk library can be created manually by entering individual anesthesia/surgery code combinations into the library. Or it can be created automatically by importing a file obtained from the American Society of Anesthesiologists (ASA) that includes all anesthesia/surgery code combinations. Whether using Basic Anesthesia Billing or

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

Help Guide for NextGen® Enterprise PM 8

Setting Up Anesthesia Concurrency Billing

Anesthesia Concurrency Billing in NextGen® Enterprise PM involves setup in the following areas in File Maintenance: Service Items library (see Service Items for Anesthesia Billing) Payers master file (see Payers for Anesthesia Billing Claim Modifiers library (see Claim Modifiers Library Submitter Profiles library (electronic claims) (see Submitter Profile Options for Anesthesia Billing) Claim Printing library (paper claims) (see Claim Printing Library Options for Anesthesia Billing) Anesthesia library (see Anesthesia Library) ASA Crosswalk library (see ASA Crosswalk Library) Locations master file (see Enable the ASA Crosswalk for Charge Posting) Practice Preferences (see Practice Preferences Options for Anesthesia Billing) User Preferences (see User Preferences for Anesthesia Concurrency Billing) Anesthesia Library ASA Crosswalk Library User Preferences for Anesthesia Concurrency Billing Parent topic: Anesthesia Concurrency Billing

Help Guide for NextGen® Enterprise PM 8

Anesthesia Concurrency Billing

Anesthesia Concurrency Billing in NextGen® Enterprise PM can be setup and used by practices that must meet specific requirements on professional claims for anesthesia services that occur at the same time, or concurrently. Concurrency billing is typically used when the practice submits 837P/1500 claims for numerous anesthesia procedures that are administered in a hospital surgery department setting by Anesthesiologists and medically directed Certified Registered Nurse Anesthetists (CRNA). An Anesthesiologist can personally administer anesthesia to a patient. They can also oversee the administration of anesthesia by Certified Registered Nurse Anesthetists (CRNA) and Anesthesiologist Assistants (AA). When an anesthesiologist oversees up to four concurrent cases, it is considered "medical direction". In NextGen® Enterprise PM, an Anesthesia Concurrency Audit process is run prior to billing and creating claims. The audit looks at encounters with charges that were rendered by anesthesia prov

Setting Up Anesthesia Concurrency Billing

Recommendations

Setting Up Basic Anesthesia Billing

Charge Posting for Anesthesia Billing

ASA Crosswalk Library

Anesthesia Library

Setting Up Anesthesia Concurrency Billing

Anesthesia Concurrency Billing

Setting Up Basic Anesthesia Billing

Charge Posting for Anesthesia Billing

ASA Crosswalk Library

Anesthesia Library

Setting Up Anesthesia Concurrency Billing

Anesthesia Concurrency Billing