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 provider for patients with no insurance and it should be counted as a Health Center qualifying encounter.

• 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 it should be counted as a Health Center qualifying encounter.

• 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.