Configuring Claim Edits for CPT® II Claims-Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submitting CPT® II Codes Automatically

You can select the automating submission method after completing the configuration steps. The CPT® II code automatic submission functionality facilitates claim-based quality measure reporting by automatically assigning and submitting CPT® II codes. Selected HEDIS measures are mapped to the CPT® II code system on the Coded Results Mapping template. Practices can configure additional measures. When the CPT® II code automation functionality is enabled, documentation that meets the criteria setup on the Coded Results Mapping template automatically assigns a CPT® II code when the template that contains the configured field is saved. You can either send the CPT® II code directly to the Superbill without assigning a diagnosis, or you can send it to the Finalize template where a provider assigns the diagnosis before submitting to the Superbill. Note: You must report any measure excluded from claims-based reporting on the Exception/Measures template. The auto-submission methods are: Automatic:

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Manually Submitting CPT® II Codes for Claims-Based Reporting

You can configure codes and their descriptions for an encounter, and select the CPT II code for a patient for a specific encounter. To use the manual submission option, you must set up the codes and exclusion modifiers, and then assign the measure to the provider on the Provider CQM Maintenance template. Note: To exclude a measure from claims-based reporting, you must use the Exceptions/Measures template to report the exception. Additionally, you must configure the Claim Edit Library. When CPT II codes are configured, providers can select and submit the necessary codes using the Procedure Coded Measures panel on the Exceptions/Measures template. The defined quality measures for providers, patients, and encounters are displayed in the grid in the Procedure Coded Measures panel. Configuring Claim Edits for CPT II Claims-Based Reporting You must configure the claim edits from the Claims Edit Library for CPT II codes. Parent topic: Reporting CPT II Procedure Codes See also Configuring Sett

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submitting Procedure Coded Measures

You can select and submit a procedure code to satisfy a claims-based measure. The Procedure Coded Measures panel on the Exceptions/Measures template displays a grid with configurable Quality measures (identified by QID) and HEDIS measures from the Provider CQM Maintenance template and Claims Based Reporting Setup panel. Measures that are excluded from claims-based reporting must be reported on the Exception/Measures template. You can submit exceptions for claims-based measures in the Procedure Coded Measures panel. The measures that display modifiers in the Modifier column are exceptions. Procedure Coded Measures Submit CPT II Procedure Codes and Measure Exceptions You can manually submit CPT II procedure codes and the measure exceptions in the Procedure Coded Measures panel on the Exceptions/Measures template. Submit Claims Based Correction Report You can generate the claims-based billing correction report to submit the new CPT II codes for manual billing. Parent topic: Viewing Except

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submitting CPT® II Codes Automatically without Diagnosis

You can to configure additional options to automatically submit the CPT® II codes to Superbill. In addition to the CPT II configuration in the “Common Configuration for CPT II Claims Based Reporting” section, you also need to configure the following areas to automatically submit the CPT II codes without the diagnosis option: Claim Edit Library Practice Configuration When configured to automatically submit the CPT II codes, the codes are automatically assigned and submitted to Superbill for a patient documentation that meets the criteria mapped for a measure on the Coded Results Mapping template. The claim edits activated during the configuration select all claims without a diagnosis. The diagnosis can be added later in NextGen® Enterprise PM. You need to report measure exceptions on the Exceptions/Measures template for the CPT II code auto-submission functionality to work. Enable Automatic Submission of CPT II Codes You can automatically submit CPT® II codes to the Superbill and Proced

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Submit Claims Based Correction Report

You can generate the claims-based billing correction report to submit the new CPT II codes for manual billing. When there is a change in the CPT II codes that are already billed, the new codes are not pushed again for re-billing. Instead, the new CPT II codes are available in the correction report and those must be billed manually. Open NextGen® Enterprise EHR. From the File menu, navigate to Reports > Crystal Reports. The Report Dialog window opens. Report Dialog Expand the This encounter for Current Patient option, and select Claims Based Correction Report. Select the Preview button.The Claims based billing correction report opens in the Crystal Reports Viewer. The new codes are displayed in the Updated code column. Parent topic: Submitting Procedure Coded Measures

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

Configuring Settings for CPT® II Claims Based Reporting

You can enable the CPT II reporting feature by configuring a set of prerequisites. You must complete the following common configurations to enable CPT II code claims-based reporting. Download the CPT code set. For more information about downloading the CPT code set, go to NextGen Healthcare Success Community, and download the CPT4 Utility Guide for NextGen® Enterprise. Configure each CPT II code in Service Item Library Maintenance to enable the submission of a $0 charge claim. Review the mapping or add additional measures on the Coded Results Mapping template. Configure and assign measures to providers on the Provider CQM Maintenance template. Configure CPT II codes for claims-based reporting in Service Item Library. After you complete the required configurations, you must complete the configurations specific to the CPT II code submission option (manual or automated) that your practice uses. See the corresponding section in this document for the remaining configuration steps for the CP

Configuring Claim Edits for CPT® II Claims-Based Reporting

Recommendations

Submitting CPT® II Codes Automatically

Manually Submitting CPT® II Codes for Claims-Based Reporting

Submitting Procedure Coded Measures

Submitting CPT® II Codes Automatically without Diagnosis

Submit Claims Based Correction Report

Configuring Settings for CPT® II Claims Based Reporting

Configuring Claim Edits for CPT® II Claims-Based Reporting

Submitting CPT® II Codes Automatically

Manually Submitting CPT® II Codes for Claims-Based Reporting

Submitting Procedure Coded Measures

Submitting CPT® II Codes Automatically without Diagnosis

Submit Claims Based Correction Report

Configuring Settings for CPT® II Claims Based Reporting