Calculating Charge Units and Price during Charge Posting

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 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

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

Rounding Methods Field Description

The following table describes the rounding methods for the payers and for self-pay. Field Description Base Minutes The standard Base Minute values (15, 30, 60, and 240) are displayed in separate rows with a default rounding method 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 code is set to 15 minutes, and the 15 minute rounding method is set to the default Down at 7, Up at 8, Less than 8 is 0, then the units are calculated based on the total time entered for a charge. Charge Total Time = 7 minutes Units = 0 Charge Total Time = 8 minutes Units = 1 Charge Total Time = 15 minutes Units = 1 Charge Total Time = 22 minutes Units = 1 Charge Total Time = 23 minutes Units = 2 To customize a Base Minute Rounding Method, select the row for the desired Base Minutes and modify the fi

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

Calculating Charge Units and Price during Charge Posting

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