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 standard vaccine CPT4 codes Treasts VFC-eligible patients but uses standard vaccine CPT4 codes Has Medicare patients and bills Flu vaccines	Set up the Medicare Billing Code (Q codes) in the NDC Library. Select your practice's NDC Library in File Maintenance > Practice > Preferences > Libraries.

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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 Billing Setup Best Practices

After the Immunizations have been setup, the charges are sent to NextGen® Enterprise PM for billing processing. As of January 1, 2014, to enable the government to identify vaccine brands for vaccine distribution planning, Immunization charges must have an associated NDC ID, including Basis of Measure and Drug Unit Count fields. Therefore, you must configure a NDC ID in the NDC Library. To help your practice streamline this process, you need to ensure that billing administrators and appropriate clinical staff set up your NDC ID codes and SIM codes appropriately. The following are best practices and considerations you need to consider for more accurate billing. Ensure you have downloaded the most recent CPT4 codes for the current year. Ensure you have run the most recent Medication Update. Before you set up the vaccine inventory, select your practice’s default NDC Library and set up the NDC Library. The NDC details in the NDC Lookup when you add or update the vaccine inventory; or when y

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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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Add Custom VFC SIM Codes to a Service Item Library

If your practice administers immunizations to VFC eligible patients, you can create custom VFC SIM codes for billing purposes. The steps to add Custom VFC SIM codes to the SIM Library is similar to adding a new SIM code. Note: After adding the custom VFC SIM codes, be sure to verify that the NDC ID Number exists in the NDC Library. Select File Maintenance > Libraries > Service Items. From the Service Items List window, select the library to update. The Service Item Library Maintenance window opens. Select open menu and select New. The three service item fields turn red. Do one of the following: In the CPT4 Code, enter a CPT4® code from your list of service items, and select Enter. Select the CPT4® code in the search results. The details for the selected CPT4® code appears. In the Service Item #, enter VFC as a suffix to the CPT4® Code. For example, 90657VFC. In the General tab, do the following: In Eff Date, enter the effective date of the custom VFC SIM code. In Exp. Date, enter the e

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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

NextGen® Enterprise EHR Help

Setting Up and Mapping Custom SIM Codes for Immunizations Billing

If your practice administers immunizations for VFC-eligible patients, for billing purposes, you can set up custom VFC SIM codes for these patients. Using the Vaccine Billing option in File Maintenance, you can indicate that a VFC custom SIM code is a default billing code. The default indicates that an immunization is being administered for a VFC-eligible patient. When administering Immunizations using the Orders' Immunization function, the default VFC Vaccine Billing code automatically displays in the Vaccine Billing code field on the Create New/Update Immunizations Order for patient name window. After the immunization is Completed or Partially Administrated, the Vaccine Billing codes are then passed to NextGen® Enterprise PM for charge processing. Recommended Workflow for Configuring and Processing Custom VFC SIM Codes Mapping Unique SIM Codes and Selecting VFC SIM Code Defaults Parent topic: Setting up Immunizations Tasks to Streamline Vaccine Billing

Immunizations Setup Best Practices for Billing VFC and Medicare Patients

Recommendations

Set up the Vaccine Inventory for Immunizations

Immunizations Billing Setup Best Practices

Setting up Immunizations Tasks to Streamline Vaccine Billing

Add Custom VFC SIM Codes to a Service Item Library

Recommended Workflow for Configuring and Processing Custom VFC SIM Codes

Setting Up and Mapping Custom SIM Codes for Immunizations Billing

Set up the Vaccine Inventory for Immunizations

Immunizations Billing Setup Best Practices

Setting up Immunizations Tasks to Streamline Vaccine Billing

Add Custom VFC SIM Codes to a Service Item Library

Recommended Workflow for Configuring and Processing Custom VFC SIM Codes

Setting Up and Mapping Custom SIM Codes for Immunizations Billing