Perform AUC Check

NextGen® Enterprise EHR Help

Select ABN Option for Failed Medical Necessity Check

Before you begin Ensure that you have the required license for Medical Necessity check. Ensure that you have configured medical necessity check in File Maintenance. Ensure that you have selected the insurance information for the patient in the All tab. Note: Computerized Physician Order Entry (CPOE) derives the insurance settings from the Practice Preferences configurations. For more information on Practice Preferences in File Maintenance, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise. For a test that does not meet the medical necessity criteria for insurance reimbursement, the patient can consent to financial responsibility by signing the Advance Beneficiary Notice (ABN). You can print the ABN for the patient to read and sign and record the patient's ABN status. Open CPOE. Select an order item. Assign a diagnosis to the selected order item. Select the Laboratory or Diagnostic tab and check if the order ite

NextGen® Enterprise EHR Help

Check Medical Necessity for Laboratory and Diagnostic Order Items

Before you begin Ensure that you have the license for medical necessity check. Ensure that you have configured medical necessity check in File Maintenance. Ensure that you have selected the insurance information for the patient in the All tab. Note: Computerized Physician Order Entry (CPOE) derives the insurance settings from the Practice Preferences configuration. For more information on Practices Preferences in File Maintenance, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise. Medical necessity includes a defined list of tests that are linked to medical problems. Government insurances such as Medicare Part B require approval of a test's necessity before it can be ordered and paid for. CPOE automatically checks for medical necessity when you assign a diagnosis to a laboratory and diagnostic order item. You can view the medical necessity check results and print the Advance Beneficiary Notice (ABN) for order i

NextGen® Enterprise EHR Help

Place Selected Orders

Before you begin While selecting your orders, ensure that you address all the mandatory indicators, which are denoted by . Ensure that you have completed the charge submission and payers information configurations in File Maintenance so that your practice can post charges for performing laboratory and diagnostic tests, and also automatically include Healthcare Common Procedural Coding System (HCPCS) codes and Modifiers in the charges for diagnostic orders with Appropriate Use Criteria (AUC) check. Note: For more information on charge submission configurations, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise and Procedures and Superbill Modules User Guide for NextGen® Enterprise. You can place your selected orders and view a summary of the of the placed orders in Placed Items. Note: In File Maintenance, if you have configured Practice Preferences for automatic billing of laboratory or diagnostic orders, Comput

NextGen® Enterprise EHR Help

Manage Diagnostic Order Details

In the Diagnostic tab, you can view and modify the details of your selected diagnostic order items, associated diagnoses, and other general information, such as billing type and order priority. Open CPOE. Select an order item. Assign a diagnosis to the order item. To view and modify the order item, do one of the following: Select the Diagnostic tab. In the All tab, select the order item's link under Description. Note: When you select multiple diagnostic order items, Computerized Physician Order Entry (CPOE) groups the order items according to the performing entity you select. Under the Diagnostic Order section, do any of the following: View the patient's treatment history. Select a Laterality value for the diagnostic order item. Note: L indicates left, R indicates right, and B indicates bilateral. Modify the assigned diagnosis. To change the performing entity for the selected diagnostic order item, select the corresponding cross icon and reselect the order item with a different perform

NextGen® Adaptive Content Engine Help Enterprise 8

Configure AUC Scores

Configure AUC Scores Configure AUC Scores You must configure settings in File Maintenance and on the Practice Configuration practice template to use the AUC score wizard. To successfully use the AUC score wizard, you must configure the following settings in File Maintenance. Open NextGen® Enterprise EHR. To activate the AUC rules for the assigned payer, in the File Maintenance, do the following. In the Master Files, click Payers. The Payers List window opens. Double click a payer from the list. The Modify Payer Information window for the payer opens. Click the Orders Module tab, and select the Enable payer for Appropriate Use Criteria rules for Advanced Radiology Imaging orders check box. Apply the AUC for all payers within the same financial class, if necessary. To automate the inclusion of modifier and G-code in the procedure billing, select the Include AUC /HCPCS code modifier automatically option. Select a payer in the encounter level insurance for the current patient. In the Order

NextGen® Adaptive Content Engine Help Enterprise 8

Order Diagnostic Tests by AUC Score

You can generate the Appropriate Use Criteria (AUC) for diagnostic tests. Before you begin You must configure the AUC in File Maintenance and map them in the Care Guidelines Setup practice template for a patient to generate an AUC score for an advanced imaging test and then place the appropriate order. In the Practice Configuration practice template, you must ensure that the Enable Appropriate Use Criteria (AUC) Rules check box is selected and the Enable Order Module check box is not selected. Open NextGen® Enterprise EHR. On a patient encounter, open any of the standard visit templates (for example, the Intake) template. On the template header, select the Care Guidelines link. The Care Guidelines Paged View template opens. In the Care Guidelines grid, select a diagnostic test. The AUC Score Wizard opens. Select the check boxes for exam indications and then select Review AUC. AUC Score Wizard The AUC Score Wizard displays the AUC score for the selected test. Review the AUC score genera

Perform AUC Check

Before you begin

Recommendations

Select ABN Option for Failed Medical Necessity Check

Check Medical Necessity for Laboratory and Diagnostic Order Items

Place Selected Orders

Manage Diagnostic Order Details

Configure AUC Scores

Order Diagnostic Tests by AUC Score

Select ABN Option for Failed Medical Necessity Check

Check Medical Necessity for Laboratory and Diagnostic Order Items

Place Selected Orders

Manage Diagnostic Order Details

Configure AUC Scores

Order Diagnostic Tests by AUC Score