Behavioral Health Rounding

Field	Description
Base Minutes	The "standard"Base Minutevalues (15, 30, 60 and 240) display in separate rows with a default rounding method for the payer as follows: 15 minutes:Down at 7, Up at 8, Less than 8 is 0 30 minutes:Down at 14, Up at 15, Less than 15 is 0 60 minutes:Down at 29, Up at 30, Less than 30 is 0 240 minutes:Down at 119, Up at 120, Less than 120 is 0 For example, if the base minutes for a SIM code is set to15 minutes, and the 15 minute rounding method for the payer is set to the defaultDown at 7, Up at 8, Less than 8 is 0, then units are calculated based on the total time entered for a charge as follows: Charge Total Time = 7 minutes Units = 0 Charge Total Time = 8 minutes Units = 1 Charge Total Time = 15 minutes Units = 1 Charge Total Time = 22 minutes Units = 1 Charge Total Time = 23 minutes Units = 2 To customize aBase Minute Rounding Methodfor the payer, select the row for the desiredBase Minutesand modify the following fields as needed.
Down/Exact	Select one of the following for theBase Minutevalue: Down (default) Exact
Down At	This field is enabled only whenDownis selected. Enter the number of minutes, between 1 and 999999, at which units round down for the payer. The default value is calculated as follows: Down At= (Base Minutes/ 2) - 1
Up At	This field displays the number of minutes at which units round up for the payer. The field is disabled and is updated by modifying theDown Atvalue. The value is calculated as follows: Up At=Down At+ 1
Less Than is 0	Enter the number of minutes, between 1 and 999999, at which units round down to zero for the payer. The default value is calculated as follows: Less Than is 0=Base Minutes/ 2
Decimal Place	This field is enabled only whenExactis selected. Select one of the following: First (default): Rounds units to the first decimal place. Second: Rounds units to the second decimal place.
Behavioral Health Custom Base Minute Rounding Methods	This additional section appears only if you have set up one or more Behavioral Health SIM codes with "custom"Base Minutesin the Service Items Library. Each "custom"Base Minutevalue displays in a separate row with a default rounding method for the payer. The defaultDown At,Up AtandLess Than is 0values are calculated as described above. To customize aCustom Base Minute Rounding Methodfor the payer, select the row for the desiredBase Minutesand modify the fields as described above.

File Maintenance Help for NextGen® Enterprise 8

Anesthesia Rounding

If Anesthesia SIM codes with Base Units are set up in the Service Items Library for billing in NextGen® Enterprise PM, then the following Anesthesia Rounding options should be defined for each payer. For more information on Anesthesia Billing, go to the NextGen Healthcare Success Community and download the Anesthesia Billing User Guide for NextGen® Enterprise PM. Field Description Anesthesia Minutes Per Unit Enter the number of minutes, between 5 and 60, that make up one anesthesia time unit for the payer. The default value is 15. The below examples illustrate how time units would be calculated for a 60 minute anesthesia procedure: 60 minutes / 5 minutes per unit = 12 time units 60 minutes / 10 minutes per unit = 6 time units 60 minutes / 15 minutes per unit = 4 time units 60 minutes / 20 minutes per unit = 3 time units 60 minutes / 30 minutes per unit = 2 time units 60 minutes / 60 minutes per unit = 1 time unit Note: Self-pay encounters use the default Anesthesia Minutes Per Unit = 1

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Rounding

If Behavioral Health SIM codes with standard (15, 30, 60, 240) or custom Base Minutes are set up in the Service Items Library for billing in NextGen® Enterprise PM, then the Behavioral Health Base Minute Rounding Methods should be defined for each payer. The rounding methods affect how the units are calculated on a behavioral health charge for the payer based on the total time entered for the charge. For more information on Behavioral Health Billing, go to the NextGen Healthcare Success Community and download the Behavioral Health Billing User Guide for NextGen® Enterprise PM. Field Description Base Minutes The "standard"Base Minutevalues (15, 30, 60 and 240) display in separate rows with a default rounding method for the payer as follows: 15 minutes:Down at 7, Up at 8, Less than 8 is 0 30 minutes:Down at 14, Up at 15, Less than 15 is 0 60 minutes:Down at 29, Up at 30, Less than 30 is 0 240 minutes:Down at 119, Up at 120, Less than 120 is 0 For example, if the base minutes for a SIM co

Help Guide for NextGen® Enterprise PM 8

Calculating Roll-Up Charge Units and Price during Billing

In NextGen® Enterprise PM, the Units and Price for each behavioral health charge is calculated during charge posting. For more information, see Calculating Charge Units and Price during Charge Posting. When multiple behavioral health charges on a single encounter have the same CPT4 code, the same modifiers, the same base minutes and the same unit price, those charges roll-up, or bundle, into a single line item on the claim. The Units and Price for a roll-up charge on claims is calculated during the billing process as follows: The total time in minutes for the roll-up charge is calculated by adding the total time from all charges included in the roll-up. Charge 1 Time + Charge 2 Time = Total Time The roll-up charge units are then calculated by dividing the total time by the base minutes defined for the SIM code. Any additional minutes are rounded using the base minute rounding method configured for the payer. Total Time / Base Minutes = Units Note: The SIM code Base Minutes is either a

File Maintenance Help for NextGen® Enterprise 8

Payer Listing Behavioral Health Rounding Rules Report

The Payer Listing Behavioral Health Rounding Rules report includes information from the Payers master file in File Maintenance. Information on the report pulls from the Modify Payer Information window for payers with Behavioral Health Base Minute Rounding Rules defined. Note: This report uses enhanced reporting functionality. For more information, go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM and see Enhanced Reports. The report includes the following information: Column Name Description Data Populates From Payer Name Payer Name Payer Name field of the Payer Defaults-1 tab Payer Alias Payer Alias Payer Alias Name field Payer Defaults-1 tab BH Base Minutes Behavioral Health Base Minutes Behavioral Health Base Minutes (15, 30, 60, 240) and Behavioral Health Custom Base Minutes fields of the Defaults-2 > Rounding RulesStandard and custom minutes are sorted in ascending order for each payer. Note: Custom minutes (other than

Help Guide for NextGen® Enterprise PM 8

Set Up Rounding Methods for Self-Pay

Access NextGen® Enterprise PM. On the Admin menu, select Preferences, and then select Practice. The Practice Preferences window opens. From the Preference List on the left, select Charge Entry. Select the Behavioral Health Charges – Self-Pay Only tab. Set up Behavioral Health Base Minute Rounding Methods for the self-pay encounter in the practice. For more information, see Rounding Methods Field Description. The custom minutes appear in the Behavioral Health Custom Base Minute Rounding Methods section only if you set up one or more Behavioral Health SIM codes with custom base minutes in the Service Items library. Each custom base minute value is displayed in a separate row with a default rounding method for self-pay. The default Down At, Up At, and Less Than is 0 values are calculated. You can customize Behavioral Health Custom Base Minute Rounding Method for self-pay by selecting the row for the desired Base Minutes and modifying the fields. To save changes and close the window, selec

Help Guide for NextGen® Enterprise PM 8

Calculating Charge Units and Price during Charge Posting

In NextGen® Enterprise PM, the Units and Price for a behavioral health charge is calculated during charge posting as follows: The total time in minutes is calculated from the start and stop times entered for the charge. Stop Time – Start Time = Total Time The charge units (quantity) are then calculated by dividing the total time by the base minutes defined for the SIM code. Any additional minutes are rounded using the base minute rounding method configured for the payer. Total Time / Base Minutes = Units Note: The SIM code Base Minutes is either a ‘standard’ value (15, 30, 60, 240) or a ‘custom’ value. The payer Base Minute Rounding Method is either a ‘default’ method or a ‘custom’ method configured for the base minute value. The charge price is then calculated by multiplying the units by the unit price defined for the SIM code. Units X Price = Extended Price Example: SIM Code Base Minutes: 30 minutes SIM Code Price: $50.00 Payer Rounding Method: Down at 14, Up at 15, Less than 15 is 0

Behavioral Health Rounding

Recommendations

Anesthesia Rounding

Behavioral Health Rounding

Calculating Roll-Up Charge Units and Price during Billing

Payer Listing Behavioral Health Rounding Rules Report

Set Up Rounding Methods for Self-Pay

Calculating Charge Units and Price during Charge Posting

Behavioral Health Rounding

Anesthesia Rounding

Behavioral Health Rounding

Calculating Roll-Up Charge Units and Price during Billing

Payer Listing Behavioral Health Rounding Rules Report

Set Up Rounding Methods for Self-Pay

Calculating Charge Units and Price during Charge Posting