Example Positive Variance

Help Guide for NextGen® Enterprise PM 8

Example Negative Variance

In the below example, the individual charge lines total 0.8 units at $80. Roll-up logic will bill 0.7 units at $70 on the claim. Therefore, during the billing process, a "variance" charge will deduct –0.1 unit at –$10 from the encounter. This ensures that the $70 expected reimbursement from insurance can be posted to a $70 balance in NextGen® Enterprise PM. Otherwise, a $70 reimbursement on an $80 balance would leave a balance. Payer Rounding: Exact units to the first decimal place Charge 1 CPT4 / Price: 90862 / $100.00 per unit Base Minutes: 60 Start/Stop Times: 10:00 – 10:21 = 21 minutes Quantity/Units: 0.4 unit Charge Amount: 0.4 unit X $100.00 = $40.00 Charge 2 CPT4 / Price: 90862 / $100.00 per unit Base Minutes: 60 Start/Stop Times: 11:00 – 11:21 = 21 minutes Quantity/Units: 0.4 unit Charge Amount: 0.4 unit X $100.00 = $40.00 Charge Totals: 90862; 0.8 unit; $80.00 Roll-up Totals: 21 minutes + 21 minutes = 42 minutes = 0.7 unit Roll-up Claim: 90862; 0.7 unit; $70.00 Variance: –0.1

Help Guide for NextGen® Enterprise PM 8

Charge Options Field Descriptions

Use the following table to setup charge options. Field Description Disable Variance Calculation This check box controls whether or not a variance will be calculated for payers using this library. To enable variance calculations, leave this check box blank and complete all remaining fields on the tab. During the billing process, variance will be calculated, and a variance SIM will be added to the encounter if a positive or negative variance exists. To disable variance calculations, select this check box. All remaining fields on the tab become unavailable. During the billing process, variance will not be calculated, and a variance SIM will therefore not be added to the encounter. Note: If selected, the Claim Production Status report in NextGen® Enterprise PM displays the following green message when the encounter passes claim edits: Behavioral health variance charge not inserted due to library settings. Insert SIM with Variance Amount on Roll-up Charges Service Item # Select the SIM code

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

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

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

Example Positive Variance

Recommendations

Example Negative Variance

Charge Options Field Descriptions

Set Up Charge Options

Calculating Roll-Up Charge Units and Price during Billing

Calculating Charge Units and Price during Charge Posting

Set Up Charge Options

Example Negative Variance

Charge Options Field Descriptions

Set Up Charge Options

Calculating Roll-Up Charge Units and Price during Billing

Calculating Charge Units and Price during Charge Posting

Set Up Charge Options