Immunizations Billing Setup Best Practices

NextGen® Enterprise EHR Help

Set up the Vaccine Inventory for Immunizations

Before you start, run the most recent Medications Update. Set up your practice's Vaccine Inventory. Note: By default, the CPT code is mapped to the Service Item Master code. If your practice uses custom SIM codes, you can map these codes to the appropriate CPT code in File Maintenance > Systems > Vaccine Billing. Before building your vaccine inventory, it is recommended that you map your custom (or alternate) SIM codes, if necessary. Set up specific lot numbers for a component, if necessary. If your practice administers Immunizations to VFC-eligible patients and you have set up custom VFC SIM codes, you must select the VFC SIM code as the default or non-default using the Vaccine Billing option in File Maintenance. If your practice administers Flu Immunizations to patients with Medicare as the payer, you can set up the alternate Medicare Billing codes (Q codes) in the NDC Library to ensure accurate billing. Set up the Immunizations Practice Preferences: Allergy Review option Ignore pedi

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Immunizations Setup Best Practices for Billing VFC and Medicare Patients

If your practice does the following: Follow These Best Practices: Uses standard CPT4 codes only Has Medicare patients and bills Flu vaccines Set up altenate Medicare Billing Code (Q codes) in the NDC Library. Select your practice's NDC Library in File Maintenance > Practice > Preferences. Tip: The Q codes are added to your practice's Service Item Library (SIM) when the CPT codes are updated annually. Uses CPT4 codes and custom SIM codes (for example, no charge billing and VFC billing) Treats VFC-eligible patients and uses custom VFC SIM codes Has Medicare patients and bill Flu vaccines Set up a custom VFC SIM code for a specific CPT4 code in the Service Item Library. Define the VFC SIM code default in Vaccine Billing by mapping to the appropriate CPT4 Code. Note: To be able to set up the VFC code in Vaccine Billing, you must apply Hot Fix 51. Set up Medicare Billing Code (Q codes) in the NDC Library. Select your practice's NDC Library in File Maintenance > Practice > Preferences. Uses

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Setting up Immunizations Tasks to Streamline Vaccine Billing

To streamline vaccine billing as you complete various Immunizations tasks, ensure that billing administrators and appropriate clinical staff set up your NDC ID codes and SIM codes appropriately. Set up and map Custom SIM Codes for Immunizations Billing Set up Vaccine Billing Administration codes. Before you set up the vaccine inventory, select your practice’s default NDC Library and set up the NDC Library. Note: This enables the system to display the NDC details in the NDC Lookup when you add or update the vaccine inventory; or when you administer Immunizations in the Immunizations module. For accurate billing of alternate Medicare billing codes of certain Flu vaccines, your billing administrators also need to set up the NDC ID codes in the NDC Library. If you administer VFC Immunizations to VFC-eligible patients in your practice, for VFC billing purposes, you can configure unique custom SIM codes for the VFC and non-VFC patients for each location. Setting Up and Mapping Custom SIM Cod

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Immunization Pre-Setup Practice Considerations

Before setting up your Vaccine Inventory, the Immunizations options and preferences, refer to the following sections to help you determine the best setup process for your practice. Terms to Know before Immunizations Setup Immunizations Setup Process Overview Immunizations Setup Procedures Immunizations Workflow Considerations Immunizations Billing Setup Best Practices Immunizations Setup Best Practices for Billing VFC and Medicare Patients Terms to Know before Immunizations Setup Set up the Vaccine Inventory for Immunizations Parent topic: Managing Lab Orders and Immunizations

NextGen® Enterprise EHR Help

Recommended Workflow for Configuring and Processing Custom VFC SIM Codes

The following process is a recommended best practice for configuring and mapping your custom VFC SIM codes. For more detailed information, refer to the references. Set up your custom VFC SIM codes in the SIM Library in File Maintenance > Libraries. Verify that the custom VFC SIM code's NDC ID number is in the NDC Library in File Maintenance > Practice Preferences > Orders Module > Immunizations. Map the custom VFC SIM Code to the CPT4 code and select the appropriate check box to indicate that the code is the Default VFC code (VFC Default) or not (Non-VFC Default), in File Maintenance > System > EHR > Vaccine Billing. Select the appropriate vaccine and administer the Immunization for the VFC-eligible patient in EHR > Orders > Immunizations. To verify the charges in NextGen® Enterprise EHR, access the Superbill module or the NextGen® Enterprise EHR Procedures module, if necessary. You can also verify that the administration CPT4 code matches the item in these modules for the applicable e

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Administer Immunizations with Alternate Medicare Q Codes

If your practice administers Immunizations with Alternate Medicare codes (Q codes) to Medicare patients, you must first set up these codes in the NDC Library before placing an Immunizations order. These codes display on the Create New/Update Immunizations Order patient name window (Vaccine Details tab) in the Billing Code field. You must select these codes to ensure more accurate billing for Flu immunizations in NextGen® Enterprise PM. After you select the vaccines on the Select Vaccines tab, select the Vaccine Details tab. The Create New/Update Immunizations Order for <patient name> window opens on the Vaccine Details tab. On the Vaccine Details tab, select the vaccine, and provide the Vaccine and Immunizations details. Select a Registry from the list, if necessary. Select the Lot Number from the list or enter it manually, if necessary. The vaccine data defaults from the Vaccine Inventory, including the NDC ID if it exists. Enter additional information for the selected Immunization or

Immunizations Billing Setup Best Practices

Recommendations

Set up the Vaccine Inventory for Immunizations

Immunizations Setup Best Practices for Billing VFC and Medicare Patients

Setting up Immunizations Tasks to Streamline Vaccine Billing

Immunization Pre-Setup Practice Considerations

Recommended Workflow for Configuring and Processing Custom VFC SIM Codes

Administer Immunizations with Alternate Medicare Q Codes