Perform AUC Check

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

Perform AUC Check

Before you begin Ensure that you have configured Appropriate Use Criteria (AUC) in File Maintenance. For more information on how to configure AUC, go to NextGen Healthcare Success Community and download the latest Radiology Appropriate Use Criteria Workflow for the Orders Module for NextGen® Enterprise EHR. Ensure that you have selected the insurance information for the patient in the All tab. Note: Computerized Physician Order Entry (CPOE) derives the insurance and diagnosis settings from the Preferences configuration in Practices in File Maintenance. For more information, go to NextGen Healthcare Success Community and download the latest File Maintenance Preferences Guide for NextGen® Enterprise. Ensure that you have completed the charge submission and payers information configurations in File Maintenance, which enables your practice to post charges for performing laboratory and diagnostic tests, and also to automatically include Healthcare Common Procedural Coding System (HCPCS) cod

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

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 File Maintenance. To activate the AUC rules for the assigned payer, 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 checkbox. 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 Test Compendium, do the fo

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

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

NextGen® Adaptive Content Engine Help Enterprise 8.3.1

AUC Validation on Advanced Imaging Orders

The AUC score is used to validate the appropriateness of an Advanced Imaging order. You can initiate the American College of Radiology (ACR) Appropriate Use Criteria (AUC) score wizard from the Assessment And Plan or Procedure Order cardiology templates by selecting a radiology order or cardiology procedure such as a CT, MRI, PET, Echo, or ECG. The AUC wizard displays the AUC score, which indicates whether the selected order is the most appropriate imaging test for a specific clinical condition or not. You can either accept or cancel the AUC score. If you accept the AUC score, the Assessment And Plan or the Procedure Order template records the AUC score and prints it on the requisition document. After the order is placed, the AUC score label no longer appears on the Assessment And Plan and Procedure Order cardiology templates. The AUC information may be shared as order details when the cardiology procedure or radiology order is processed by a third party. For more information on the AU

Perform AUC Check

Before you begin

Recommendations

Check Medical Necessity for Laboratory and Diagnostic Order Items

Place Selected Orders

Perform AUC Check

Configure AUC Scores

Order Diagnostic Tests by AUC Score

AUC Validation on Advanced Imaging Orders

Perform AUC Check

Before you begin

Check Medical Necessity for Laboratory and Diagnostic Order Items

Place Selected Orders

Perform AUC Check

Configure AUC Scores

Order Diagnostic Tests by AUC Score

AUC Validation on Advanced Imaging Orders