Roll-Up Billing is an option for payers such as Medicare (RHC only) and Medicaid that have very unique and specific billing and claim requirements, and that reimburse at a flat encounter rate.
Roll-Up Billing provides the ability to roll-up multiple charges on an encounter into a single line item on the claim. The amount on that line item will equal the total sum of the rolled-up charges. The roll-up can be done by revenue code (for example, 0521) or by CPT4 Code (for example, T1015).
Note: Best practice is to use Encounter Rate Billing for both Medicare and Medicaid. In some cases, roll-up billing will not meet the billing and claim requirements for a payer (e.g. FQHC Medicare). Before proceeding with the setup for roll-up billing, always consult with a NextGen Healthcare Implementation Specialist and a Claims Analyst to confirm that this is the best setup option to meet the payer's specific billing requirements.
The roll-up billing considerations are as follows:
- Claims are not configurable. They will always reflect one line item for the rolled-up revenue code or CPT4 code with a price that equals the sum of the rolled-up charges.
- SIM Library maintenance can be challenging. Each individual SIM code must be flagged to roll-up either by revenue code or by CPT4 code for the payer on the SIM Library on the Payers tab.
- Electronic Remittance Advice (ERA) functionality may be limited.
