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 individual roll-up charges. The dollar amount on the claim for the roll-up line item is calculated using the total units multiplied by the unit price defined for the SIM code.

Behavioral Health Billing in NextGen® Enterprise PM involves the following set up in File Maintenance.

• Service Items Library
• Behavioral Health Billing Library
• Non-Coordinated SIM Library
• Providers Credentialing Tab
• Claim Modifiers Library
• Claim Edits Library
• Default Library Selection
• Payer and Practice Level Rounding Methods
• Payer Claim Break Options
• Other Behavioral Health Billing Features