Encounter Status

Status	Definition
Unbilled	An encounter has been created, and charges may have been entered, but have not gone through the Bill process. Anesthesia encounters convert to unbilled only when the Use Convert In Progress Indicator check box is selected in NextGen® Enterprise PM Preferences > Practice > Encounters
Billed	The encounter has successfully gone through the Edit process and has been billed.
History	The encounter has gone through the Bill process and the balance is equal to zero.
Rebill	The encounter has been modified, or charges or insurance were added that warrant a new generation of a claim. For example, A charge needs to be submitted to a secondary or tertiary insurance. A new charge has been added to an encounter that previously had a History status. You have selected charges to be billed again through Balance Control.
Bad Debt	Encounter has been pre-listed for a collection agency.
In Progress	An encounter that has not been completed and so is not stated in accounts receivable.

Help Guide for NextGen® Enterprise PM 8

Creating Encounters

Encounters can be created for patients from the following areas in NextGen® Enterprise PM: Appointment Book Patient Chart Tasks Menu Charge Posting Practice Preference for Required Encounter-Level Program In a practice, a program can be set to be required for an encounter for specific locations. Create an Encounter from an Appointment You can create an encounter for a patient with appointment from the appointment book. Create an Encounter from the Patient Chart You can create an encounter for a patient without appointment from the patients chart. Create an Encounter from the Tasks Menu You can create an encounter for a patient from the Tasks menu. Create an Encounter from Charge Posting You can create an encounter for a patient from charge posting. In Progress Encounters Overview An In Progress encounter is an encounter that has not been completed and therefore is not stated in accounts receivable. When an Encounter has an In Progress status, its process date is blank and it is not inc

Help Guide for NextGen® Enterprise PM 8

Significant Events for Encounters

Once enabled, significant event messages are recorded in the Patient Chart > Clinical History/Notes tab when the event occurs. Significant Event messages for encounters include the following: Encounter Accessed Encounter Alternate Diagnosis Mapped Encounter Bad Debt Status has reached $0 Balance Encounter Bill Printed Encounter Charge Alternate Diagnosis Mapped Encounter Charge Deleted Encounter Collections Agency Change Encounter Deleted Encounter Diagnosis Viewed Encounter Field Modified Encounter Guarantor Changed Encounter Insurance Deleted Encounter Insurance Re-Ordered Encounter Locked Encounter Lookup Criteria Encounter Rate Adjustment Reversed Encounter Rate SIM and Amount Removed Encounter Status Change Encounter Unlocked Enable Significant Events for Encounters There may be modifications made to patient encounters. To track these modifications, you must enable the appropriate significant events. View Significant Events for Encounters Significant events are enabled to view mod

Help Guide for NextGen® Enterprise PM 8

Encounters in NextGen® Enterprise PM

An encounter is an interaction between a patient and a provider in the practice on a specific date and time. In NextGen® Enterprise PM, office encounters are typically created from the appointment book when each patient checks in for their appointment. Facility encounters that are not related to an appointment, such as hospital and nursing home visits, can be created from the patient's chart. Clinical information related to a specific encounter is documented by the provider in NextGen® Enterprise EHR. Financial information, such as charges, billing and transactions, is entered on that same encounter by users in NextGen® Enterprise PM. The Encounters tab on Patient Chart lists all encounters for a patient, and the Encounters Detail tab on Account Profile lists all encounters for a guarantor. For more information on encounters in NextGen® Enterprise EHR, go to the NextGen Healthcare Success Community and download the Layout and Preferences Guide for NextGen® Enterprise EHR. Encounter Sta

Help Guide for NextGen® Enterprise PM 8

Bill an Individual Encounter from Encounter Lookup

Open NextGen® Enterprise PM. Select Encounter. The Encounter Lookup window opens. In the Bill Status field, select Rebill or Unbilled. Note: Encounters with a status of Bad Debt, Billed or History have already been billed. Clear the Include records without charges check box to exclude encounters that do not have charges. Enter additional Search Criteria to locate the desired encounter. Select Find. Encounters matching the search criteria display in the Encounter List section of the window. Select Encounter List, and then select the encounter to be billed in the Enc Nbr column. Right-click the encounter, and then select Bill. If the encounter is a self-pay encounter with no insurance attached, a message appears stating that do you want to bill this self-pay encounter. Select Yes. The encounter status changes from Unbilled or Rebill to Billed. If the encounter has insurance attached, the encounter goes through the claim edits process and the Claim Production Status report appears. The en

Help Guide for NextGen® Enterprise PM 8

The Billing Process

The billing process in NextGen® Enterprise PM takes encounters that are in Unbilled or Rebill status and runs those encounters through a claim edits process. Any encounter that passes the claim edits gets a pending claim created that can be printed or exported and then submitted to insurance for payment. You can run the billing process for an individual encounter on demand, or for multiple encounters in a batch. Billing an Individual Encounter You can bill an individual encounter. Bill Multiple Encounters (Batch Billing) You can bill multiple encounters on the Encounter Lookup window. Billing In Progress Encounters You can bill In Progress encounters after converting an In Progress encounter to an Unbilled encounter. Billing Anesthesia Encounters You can bill anesthesia encounters in File Maintenance. Recurring Rental Billing You can enable Recurring Rental Billing in NextGen® Enterprise PM. Parent topic: Billing

Help Guide for NextGen® Enterprise PM 8

Encounter Rate Billing Status

When an encounter is created, the Billing Status field on the Encounter Maintenance window on the Billing & Collections tab in the Encounter Rate sub-tab defaults to Undecided for primary, secondary and tertiary encounter rate billing. Billing Status Once the encounter is billed, the Billing Status automatically changes to indicate the action taken: ER Applied, Exempt, or Non ER Payer. Encounter Maintenance Encounter Rate Billing Statuses include the following: Status Description Undecided Indicates the encounter has not yet been billed. This is the default status used when an encounter is created. ER Applied Indicates the encounter was billed and that encounter rate billing was applied during the billing process. Exempt Indicates the encounter was billed and that encounter rate billing was not applied during the billing process because it was exempt due to the billing rules setup. Multi Yes Used when multiple same day encounters exist for the same encounter rate payer. This status is

Encounter Status

Recommendations

Creating Encounters

Significant Events for Encounters

Encounters in NextGen® Enterprise PM

Bill an Individual Encounter from Encounter Lookup

The Billing Process

Encounter Rate Billing Status

Creating Encounters

Significant Events for Encounters

Encounters in NextGen® Enterprise PM

Bill an Individual Encounter from Encounter Lookup

The Billing Process

Encounter Rate Billing Status