NextGen Edits is the ideal solution for your practice’s reimbursement concerns, allowing you to quickly determine whether an insurer will reimburse you for a specific procedure or service.

NextGen Edits identifies those procedures Medicare may deny (because the service is considered inherent with another procedure performed that day, or because of age or gender discrepancies). The software also alerts you when diagnosis codes don’t support medical necessity for a specific service.

NextGen Edits also ensures that your practice has access to the latest information from the Centers for Medicare and Medicaid Services (CMS) by purchasing claim edit and medical necessity checking software and providing you with quarterly updates.

It is crucial that providers, administrators, private payers, managed care participants, HMO/PPO/PHO/TPAs, billing services and healthcare consultants be aware of these guidelines, especially the nearly 120,000 “edit pairs” (two codes that cannot be billed on the same day by the same physician for the same patient), to maximize reimbursement.

NextGen Edits subscribers who use NextGen EPM can access these edits on demand as part of the checkout process or during billing and claim creation. If coding errors are found, they can be automatically routed to the appropriate staff member through the EPM’s WorkLog Manager for quick resolution, before submission to the payer.

Similarly, EMR users can perform medical necessity checking at the point of care and at charge creation.

The NextGen Edits package includes: