Qualifying Encounter Report

Help Guide for NextGen® Enterprise PM 8

Tracking Qualifying Encounters

Health Centers must track and report qualifying encounters because it helps in determining their per diem rate for the following calendar year. The Qualifying Encounter flag on the Claims tab of the Encounter Maintenance window in NextGen® Enterprise PM is used to assist Health Centers in determining the total number of qualifying encounters that can be reported on their UDS report. Qualifying encounters are tracked in NextGen® Enterprise PM based on setup of SIM codes in the Service Items library. Each SIM code is flagged as either a qualifying service (e.g. office visits, office procedures, outpatient surgery) or a non-qualifying service (for example, lab tests, injections). When at least one qualifying service is entered as a charge on an encounter, the Qualifying Encounter check box is automatically selected when the encounter goes through the billing process. The encounter is then counted as a qualifying encounter on reports. The Qualifying Encounter check box can be manually over

Help Guide for NextGen® Enterprise PM 8

Health Center Reports

Health Center reports are accessed from the Reports > Health Center menu in NextGen® Enterprise PM. Health Center reports include the following: Change in A/R without Encounter Rate Qualifying Encounter Sliding Fee Patient Unduplicated Patients In addition to standard filters that are available on most other reports in NextGen® Enterprise PM, such as Rendering, Payer and Location, the Health Center reports also include the following filters for patient information typically collected by Community Health Centers and Tribal Health Services practices: Homeless Status Migrant Worker Status Language Barrier Primary Medical Coverage Public Housing Primary Care School Based Health Center Tribal Affiliation Blood Quantum IHS Eligibility Status Classification/Beneficiary Descendancy Veteran Status Note: To access Health Center reports in NextGen® Enterprise PM, you must have security access rights to the following option in System Administrator: Operations > Reports > Health Center. Change in A

Help Guide for NextGen® Enterprise PM 8

Setup for Qualifying Encounters

Practice Preferences In order to track qualifying encounters in NextGen® Enterprise PM, the Enable Qualifying Encounter Billing option must be selected in Practice Preferences > Claims. This enables three check boxes in the Service Items library: Self pay Qualifying Encounter Sliding Fee Qualifying Encounter Qualifying Encounter for all payers Service Items Library Designation of a qualifying encounter is accomplished by SIM code. Automatic flagging of encounters as qualifying is based on at least one qualifying SIM code existing as a charge on the encounter. Once the Enable Qualifying Encounter Billing option is selected in Practice Preferences, the following three check boxes become available in the Service Items library. All SIM codes that are considered to be a face-to-face encounter with a qualified provider should have the three check boxes selected. Self pay Qualifying Encounter: Select this check box if the SIM code is considered a face-to-face encounter with a qualified provid

File Maintenance Help for NextGen® Enterprise 8

Service Item Library Maintenance Qualifying Encounter Descriptions

Use the following table when setting up your qualifying SIMs. Field Description Qualifying Encounter for All Payers Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Claims. Self Pay Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients with no insurance and it should be counted as a Health Center "qualifying encounter". Note: The check box available only if the Enable Qualifying Encounter Billing check box is selected in Practice Preferences > Note: Claims. Sliding Fee Qualifying Encounter Select this check box if the SIM code is considered a face-to-face encounter with a qualified provider for patients on a sliding fee schedule and

File Maintenance Help for NextGen® Enterprise 8

Set Up Qualifying SIMs

For an encounter to be marked as a qualifying encounter, at least one of the line items in the encounter must be marked as a qualifying SIM. In Practice Preferences > Claims select the Enable Qualifying Encounter Billing check box. In File Maintenance > Libraries > Service Items open the applicable library. Select an existing SIM or select the Open Menu and select New. Select the General tab. Select the qualifying-related check boxes from the Qualifying Encounter field. For more information, see Service Item Library Maintenance Qualifying Encounter Descriptions. Note: These check boxes are used primarily by CHC clients. If the code is on an encounter by itself or with other codes at the time the encounter is billed, the Qualifying Encounter check box is automatically selected on the Claims tab of the Encounter Maintenance window. This flag is used for reporting purposes primarily for grants as well as state and federal reports. Select the Payer tab, then select the Qualifying Encounter

Help Guide for NextGen® Enterprise PM 8

Encounter Maintenance - Encounter Specifics Tab

The Encounter Specifics tab displays when one or both of the following are enabled in Practice Preferences > Encounter: Encounter Specific User Defined Fields CCBHC Qualifying Encounter The Encounter Specifics tab includes the following fields: Field Description User Defined Fields: Encounter Specific 1–50 Up to fifty additional encounter-level custom fields can be created in User Defined Fields in the Encounters preferences under Practice Preferences. Enter a caption or label for one or more of the Encounter Specific 1-50 fields. Users can then make free text entries in these custom fields on an encounter. CCBHC Qualifying Encounter Select this check box to indicate the encounter includes a Certified Community Behavioral Health Clinic (CCBHC) service and should be flagged as an encounter that qualifies for CCBHC reporting purposes. If the encounter has a charge for a SIM code that is flagged as a CCBHC Qualifying Encounter code in the Service Items Library, then this check box is auto

Qualifying Encounter Report

Recommendations

Tracking Qualifying Encounters

Health Center Reports

Setup for Qualifying Encounters

Service Item Library Maintenance Qualifying Encounter Descriptions

Set Up Qualifying SIMs

Encounter Maintenance - Encounter Specifics Tab

Tracking Qualifying Encounters

Health Center Reports

Setup for Qualifying Encounters

Service Item Library Maintenance Qualifying Encounter Descriptions

Set Up Qualifying SIMs

Encounter Maintenance - Encounter Specifics Tab