Behavioral Health Charges

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

Enter Charges

Open NextGen® Enterprise PM. Select Charges on the NextGen® Enterprise PM toolbar. The Charge Posting window opens. To enter a charge, select New. Fill the fields for each charge entered on the encounter. Press the Tab key to move forward to the next field. Press the Shift and Tab keys to move back to the previous field. To complete the charge, do one of the following: To save the charge and enter another charge on the same encounter, select Next. The charge displays in the Charge Ledger at the bottom of the window. To save the charge without entering another charge, select Save. The charge displays in the Charge Ledger at the bottom of the window. To save the charge and clear the window to enter charges on another encounter, select Next Enc. To cancel the charge without saving changes, select Cancel. Field Descriptions for Entering a Charge You can enter the fields for each charge entered on the Charge Posting window. View Charges from the Charge Posting Window You can view All Patien

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

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

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

Behavioral Health Charges

Recommendations

Behavioral Health Billing

Enter Charges

Calculating Charge Units and Price during Charge Posting

Calculating Roll-Up Charge Units and Price during Billing

Behavioral Health Rounding

Behavioral Health Rounding