Payer Listing Behavioral Health Rounding Rules Report

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 Rules Standard and custom minutes are sorted in ascending order for each payer. Note: Custom minutes (other than 15, 30, 60 and 240) are created for specific SIM codes in the General tab of the Service Items library
BH Rounding Rule	Behavioral Health Rounding Rule	Behavioral Health Base Minute Rounding Methods and Behavioral Health Custom Base Minute Rounding Rules fields of the Defaults-2 > Rounding Rules The rounding rule for each base minute value displays as follows: Down at [n], Up at [n], less than [n] min is 0

Help Guide for NextGen® Enterprise PM 8

Set Up Rounding Methods for a Payer

Access File Maintenance. Select System Master Files, then PM, and then Payers. The Payer List window opens. From the list, double-click to open the desired payer. The Modify Payer Information window opens. Select the Defaults-2 tab, and then the Rounding Rules sub-tab. In the Behavioral Health Rounding section, set up Behavioral Health Base Minute Rounding Methods for the payer. For more information, refer to 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 the payer. The default Down At, Up At and Less Than is 0 values are calculated. To customize Behavioral Health Custom Base Minute Rounding Method for the payer, select the row for the desired Base Minutes and modify the fields. To save changes an

File Maintenance Help for NextGen® Enterprise 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

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

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

Behavioral Health Billing

In NextGen® Enterprise PM, you can setup the billing requirements for Behavioral Health Billing. Behavioral health SIM codes are set up in the Service Items Library with a base minute value of 15, 30, 60, 240, or a custom value. In addition, the price per time unit is defined for each SIM code. During charge posting, behavioral health SIM codes prompt for the entry of a start and stop time, and then total time units for the charge are calculated based on the times entered. Payers are set up in the Payers master file with a base minute rounding method that is used to round the total time entered on each charge up or down when calculating time units. 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 total units on the claim for the roll-up line item is calculated using the total time entered on all of the indiv

Help Guide for NextGen® Enterprise PM 8

Payer and Practice Level Rounding Methods

Behavioral Health Base Minute Rounding Methods are available at the payer-level for each payer, and at the practice-level for self-pay. The rounding methods apply to Behavioral Health SIM codes that have been defined in the Service Items Library with 15, 30, 60, 240, or custom Base Minutes. 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. Set Up Rounding Methods for a Payer Set Up Rounding Methods for Self-Pay You can set up rounding methods for self-pay for time-based billing. Rounding Methods Field Description You can select and modify the rounding methods for the payers and for self-pay. Parent topic: Behavioral Health Billing

Payer Listing Behavioral Health Rounding Rules Report

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Set Up Rounding Methods for a Payer

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Set Up Rounding Methods for a Payer

Behavioral Health Rounding

Behavioral Health Rounding

Set Up Rounding Methods for Self-Pay

Behavioral Health Billing

Payer and Practice Level Rounding Methods