Set Up Qualifying SIMs

File Maintenance Help for NextGen® Enterprise 8

Service Item Library Maintenance Qualifying Encounter Descriptions

Use the following table when setting up your qualifying SIMs. Field Description Qualifying Encounter for All Payers Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Claims. Self Pay Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with no insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Note: Claims. Sliding Fee Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients on a sliding fee schedule and

Help Guide for NextGen® Enterprise PM 8

Tracking Qualifying Encounters

Health Centers must track and report qualifying encounters because it helps in determining their per diem rate for the following calendar year. The Qualifying Encounter flag on the Claims tab of the Encounter Maintenance window in NextGen® Enterprise PM is used to assist Health Centers in determining the total number of qualifying encounters that can be reported on their UDS report. Qualifying encounters are tracked in NextGen® Enterprise PM based on setup of SIM codes in the Service Items library. Each SIM code is flagged as either a qualifying service (e.g. office visits, office procedures, outpatient surgery) or a non-qualifying service (for example, lab tests, injections). When at least one qualifying service is entered as a charge on an encounter, the Qualifying Encounter check box is automatically selected when the encounter goes through the billing process. The encounter is then counted as a qualifying encounter on reports. The Qualifying Encounter check box can be manually over

Help Guide for NextGen® Enterprise PM 8

Exempt SIM Codes from Encounter Rate Billing

If there is a service item that is exempt from encounter rate billing, you must flag it as Encounter Rate Exempt in the Service Items library. This flag makes the SIM code exempt from encounter rate billing for all payers. Note: To flag a SIM code as exempt for a specific encounter rate payer, you must select the Exclude from Encounter Rate Insertion check box on the Claim SIM Options tab of the Encounter Rate Billing library. Access File Maintenance. Select Libraries, and then Service Items. The Service Items List window opens. From the list, select a library and then select Open Menu and select Open. The Service Item Library Maintenance window opens. In the Search field, enter the SIM code and then select the code from the list. On the General tab, select the Enc rate exempt check box. Service Item Library Maintenance To save changes and close the window, select OK. Note: The Enc rate exempt setting in the SIM library works in conjunction with the Encounter Rate Exempt option on the

Help Guide for NextGen® Enterprise PM 8

Qualifying Encounter Report

The Qualifying Encounter report allows health centers to view encounters that are flagged as qualifying encounters. The report is a modified version of Charges report (daily report). It shows the number of qualifying encounters for the selected date range. Qualifying encounters are those that have at least one charge for a SIM code that is flagged as Qualifying Encounter in SIM library (Service Item Library Maintenance > Payer tab). Encounters are flagged as qualifying encounter on the Encounter Maintenance > Claims tab as soon as a qualifying charge is added. Note: This report is not intended to match or be a substitute for the reports generated in NextGen® UDS Reporting. To access the report in NextGen® Enterprise PM, select the Reports menu and select Health Center and then select Qualifying Encounter. Qualifying Encounter Report Columns Parent topic: Health Center Reports

Help Guide for NextGen® Enterprise PM 8

Tracking CCBHC Qualifying Encounters

The Encounter Specifics tab of the Encounter Maintenance window includes a CCBHC Qualifying Encounter check box. The check box is used to indicate that an encounter qualifies for inclusion on reports for the Certified Community Behavioral Health Clinic (CCBHC) program. Note: The check box is available for selection only if the CCBHC Qualifying Encounter option is enabled in Practice Preferences > Encounters. Encounter Maintenance window; Encounter Specifics tab The CCBHC Qualifying Encounter check box can be selected for an encounter by doing one of the following: Manually select the check box on a qualifying encounter. Enter a charge on the encounter for a SIM code that is flagged in the Service Items library as a CCBHC Qualifying Encounter code. The check box is automatically selected when the charge is saved. Parent topic: Certified Community Behavioral Health Clinics (CCBHC)

Help Guide for NextGen® Enterprise PM 8

Setup for Qualifying Encounters

Practice Preferences In order to track qualifying encounters in NextGen® Enterprise PM, the Enable Qualifying Encounter Billing option must be selected in Practice Preferences > Claims. This enables three check boxes in the Service Items library: Self pay Qualifying Encounter Sliding Fee Qualifying Encounter Qualifying Encounter for all payers Service Items Library Designation of a qualifying encounter is accomplished by SIM code. Automatic flagging of encounters as qualifying is based on at least one qualifying SIM code existing as a charge on the encounter. Once the Enable Qualifying Encounter Billing option is selected in Practice Preferences, the following three check boxes become available in the Service Items library. All SIM codes that are considered to be a face-to-face encounter with a qualified provider should have the three check boxes selected. Self pay Qualifying Encounter: Select this check box if the SIM code is considered a face-to-face encounter with a qualified provid

Set Up Qualifying SIMs

Recommendations

Service Item Library Maintenance Qualifying Encounter Descriptions

Tracking Qualifying Encounters

Exempt SIM Codes from Encounter Rate Billing

Qualifying Encounter Report

Tracking CCBHC Qualifying Encounters

Setup for Qualifying Encounters

Service Item Library Maintenance Qualifying Encounter Descriptions

Tracking Qualifying Encounters

Exempt SIM Codes from Encounter Rate Billing

Qualifying Encounter Report

Tracking CCBHC Qualifying Encounters

Setup for Qualifying Encounters