Other Behavioral Health Billing Features

Help Guide for NextGen® Enterprise PM 8

Certified Community Behavioral Health Clinics (CCBHC)

Behavioral Health practices that participate in the federal Certified Community Behavioral Health Clinic (CCBHC) program may be required to track and report patient encounters when specific CCBHC services are rendered. There are nine types of CCBHC services that might be performed in either a clinic setting or a non-clinic setting, such as a home, prison, or an outreach program to homeless populations. To track CCBHC encounters and services in NextGen® Enterprise PM, the following setup must be completed in File Maintenance: Practice Preferences Service Items Library Locations Master File Enable CCBHC Qualifying Encounters Set Up CCBHC SIM Codes Set Up CCBHC Locations Tracking CCBHC Qualifying Encounters Reporting on CCBHC Qualifying Encounters Parent topic: Behavioral Health Billing

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

Help Guide for NextGen® Enterprise PM 8

Service Items Library

The Service Items Library defines all services that a practice performs. Each service code, or SIM code, includes defined parameters that affect charge posting, billing, claims, and reports in NextGen® Enterprise PM. You must set up Behavioral Health SIM codes in the Service Items library. Set Up Behavioral Health SIM Codes You can set up Behavioral Health SIM codes on the Service Item Library Maintenance window. Parent topic: Behavioral Health Billing

Help Guide for NextGen® Enterprise PM 8

Assigning Security Access Rights in System Administrator

In System Administrator, you can assign security access rights to the Behavioral Health Billing Library. You must assign access rights to one or more groups, so users can create and modify the libraries in NextGen® Enterprise PM. Set Up Security Access Rights for Behavioral Health Libraries Parent topic: Behavioral Health Billing

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

NextGen® Adaptive Content Engine Help Enterprise 8

Billing in a Behavioral Health Encounter

The Behavioral Health template set includes two primary areas that enable a provider to submit services codes to the Superbill. The Behavioral health billing section, available on multiple templates. The Finalize template Once the charges are calculated and submitted to the Superbill, the NextGen® Enterprise PM receives the charges for the services with a Start and End Time, a CPT® or HCPCS service code, a diagnosis code, as well as the date of service and the name of the provider of service. NextGen® Enterprise PM requires all of this data to be able to evaluate whether the total of the duration times may be 'rolled up'. Users can to view the submitted items and make any necessary updates. Behavioral Health Billing Section Behavioral Health Billing on the Finalize Template Virtual Visit Billing The Virtual Visit Billing section is enabled only for virtual visits. Parent topic: Behavioral Health

Other Behavioral Health Billing Features

Recommendations

Certified Community Behavioral Health Clinics (CCBHC)

Behavioral Health Billing Library

Service Items Library

Assigning Security Access Rights in System Administrator

Behavioral Health Billing

Billing in a Behavioral Health Encounter

Certified Community Behavioral Health Clinics (CCBHC)

Behavioral Health Billing Library

Service Items Library

Assigning Security Access Rights in System Administrator

Behavioral Health Billing

Billing in a Behavioral Health Encounter