Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Charges

Entering behavioral health charges on the Charge Posting window is basically the same as entering any other charge in NextGen® Enterprise PM. The primary differences for a behavioral health charge are: Start Time and Stop Time are required. The charge Units, or quantity, is calculated using the Total Time entered for the charge, the Base Minutes defined for the SIM code, and the Base Minute Rounding Method configured for the payer. For more information, refer to the Entering Charges section in the Billing and Collections User Guide for NextGen Enterprise PM. Calculating Charge Units and Price during Charge Posting Calculating Roll-Up Charge Units and Price during Billing Parent topic: Billing

Help Guide for NextGen® Enterprise PM 8

Charge and Billing Options for Health Centers

In most cases, the special setup for Health Centers applies only to Medicare and Medicaid. This includes Managed Care programs for Medicare and Medicaid which are often considered to be commercial payers. Blue Cross Blue Shield and Commercial payers typically bill as Fee-for-Service on a 1500 claim form just like at other private practices. No special setup is required for these payers. However, every state has potential for exceptions. Therefore, any payer can be setup for encounter rate or roll-up billing if needed. Encounter Rate Billing: This is an option for payers such as Medicare (FQHC / RHC) and Medicaid that have unique and specific billing and claim requirements, and that reimburse at a flat encounter rate. Encounter Rate Billing provides the ability to automatically adjust charges so that the balance reflects the payer’s expected encounter reimbursement rate/amount. In addition, an encounter rate code required by the payer on claims can be automatically inserted onto each en

File Maintenance Help for NextGen® Enterprise 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

Help Guide for NextGen® Enterprise PM 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

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

Help Guide for NextGen® Enterprise PM 8

Behavioral Health Billing Library

The Behavioral Health Billing library defines parameters for “variance” charges which can be calculated and added to encounters during the billing process for specific payers. The library also defines other claim and billing parameters that may be needed when billing Behavioral Health services to specific payers. A single library can be created and linked to the practice to be used for all payers. Or payer-specific libraries can be created and linked only to those payers. You can generate the Behavioral Health Billing report from the Behavioral Health Billing library , go to NextGen Healthcare Success Community and download the latest Reports User Guide for NextGen® Enterprise PM. Add or Modify a Behavioral Health Billing Library Parent topic: Behavioral Health Billing

Behavioral Health Billing

Recommendations

Behavioral Health Charges

Charge and Billing Options for Health Centers

Set Up Charge Options

Set Up Charge Options

Calculating Roll-Up Charge Units and Price during Billing

Behavioral Health Billing Library

Behavioral Health Billing

Behavioral Health Charges

Charge and Billing Options for Health Centers

Set Up Charge Options

Set Up Charge Options

Calculating Roll-Up Charge Units and Price during Billing

Behavioral Health Billing Library