Configuring Settings for CPT II Claims Based Reporting

NextGen® Adaptive Content Engine Help Enterprise 8

Provider CQM Maintenance System Template

You can use the Provider CQM Maintenance template to configure Quality Reporting, Quality Program, Centers for Medicate & Medicaid Services (CMS) and provider non-CMS measures. Manage Clinical Quality Measures Provider CQM Maintenance Provider CMS Measures Configure Non-CMS Provider Measures You can configure non-CMS Provider measures for CPT II codes. Configure Measures for Claims-Based Reporting On the Claims Based Reporting Setup panel, system administrators can add existing or newly-created measures to practices. Copy Provider Measures to Another Provider Exception Maintenance Viewing Exceptions and Measures You can manage exceptions and view measure details on the Exceptions/Measures template. Parent topic: System and Practice Templates Related concepts Manage Clinical Quality Measures Provider CQM Maintenance Exception Maintenance Viewing Exceptions and Measures Related tasks Provider CMS Measures Configure Non-CMS Provider Measures Configure Measures for Claims-Based Reporting C

NextGen® Adaptive Content Engine Help Enterprise 8

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

NextGen® Adaptive Content Engine Help Enterprise 8

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: activa

NextGen® Adaptive Content Engine Help Enterprise 8

Configure Non-CMS Provider Measures

You can configure non-CMS Provider measures for CPT II codes. To enable a provider to document an exception and submit a CPT II code manually, you must assign a measure to a provider. Open the Provider CQM Maintenance template. Provider Measures (not CMS) Panel In the Provider Measures (not CMS) panel, select the Provider field. Select a provider in the list. Select the System field, and select Claims Based Measures. Note: The grid displays measures that have been set up in the Claims Based Reporting Setup panel on the Provider CQM Maintenance template that matches the System selection you have selected. Select the Measure # field, and select a measure in the list.The Measure short description field displays the description of the measure. Select Add.The Provider Measures (not CMS) configuration is added to the All Providers Measure grid. Update Non-CMS Provider Measures You can update the non-CMS Provider measures that are configured for the CPT II codes. Remove Non-CMS Provider Measu

NextGen® Adaptive Content Engine Help Enterprise 8

Configure Measures for Claims-Based Reporting

On the Claims Based Reporting Setup panel, system administrators can add existing or newly-created measures to practices. On the Provider CQM Maintenance template, expand the Claims Based Reporting Setup panel. Claims Based Reporting Setup panel In the Practice(s) to View/Update section, do one of the following: To view or update measures for all practices, select the All option. To view or update measures for a practice, select the Selected option, and select a practice from the list. In the System field, do one of the following: To add an existing measure, select QID, click the Measure # field, and select a measure on the Dbp Provider Measure List window. Dbp Provider Measure List To add new claims-based measure, select Claims Based Measures. Select the Measure # field, and select <Add New> on the Dbp Provider Measure List window. You can type the measure number and measure description. Dbp Provider Measure List Note: For CPT II codes, select the Claims Based Measures system. Select

NextGen® Adaptive Content Engine Help Enterprise 8

Configure Service Item Library for CPT II Claims-Based Reporting

To send a zero charge claim, you need to enable the Send a $0 charge on claim setting for each configured CPT II code in Service Item Library. Log in to File Maintenance. Select Libraries, and then select Service Items.The Service Items List window opens. To open a service item library, do one of the following: To add an item, select Open Menu and then select New. To modify an item, double-click an item in the list. The Service Item Library Maintenance window opens. In the Search field, type a CPT II code.The Service Item Library Maintenance window displays the code details. Select the Send $0 charge on claim checkbox. Service Item Library Maintenance Select OK. Parent topic: Configuring Settings for CPT II Claims Based Reporting

Configuring Settings for CPT II Claims Based Reporting

Recommendations

Provider CQM Maintenance System Template

Manually Submitting CPT II Codes for Claims-Based Reporting

Submitting CPT II Codes Automatically

Configure Non-CMS Provider Measures

Configure Measures for Claims-Based Reporting

Configure Service Item Library for CPT II Claims-Based Reporting

Provider CQM Maintenance System Template

Manually Submitting CPT II Codes for Claims-Based Reporting

Submitting CPT II Codes Automatically

Configure Non-CMS Provider Measures

Configure Measures for Claims-Based Reporting

Configure Service Item Library for CPT II Claims-Based Reporting