Tracking Qualifying Encounters

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

Help Guide for NextGen® Enterprise PM 8

Qualifying Encounter Report

The Qualifying Encounter report allows health centers to view encounters that are flagged as qualifying encounters. The report is a modified version of Charges report (daily report). It shows the number of qualifying encounters for the selected date range. Qualifying encounters are those that have at least one charge for a SIM code that is flagged as Qualifying Encounter in SIM library (Service Item Library Maintenance > Payer tab). Encounters are flagged as qualifying encounter on the Encounter Maintenance > Claims tab as soon as a qualifying charge is added. Note: This report is not intended to match or be a substitute for the reports generated in NextGen® UDS Reporting. To access the report in NextGen® Enterprise PM, select the Reports menu and select Health Center and then select Qualifying Encounter. Qualifying Encounter Report Columns Parent topic: Health Center Reports

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

Do's and Don'ts for the UDS Report

Invoices Invoices should only be used for charges that are not considered face-to-face encounters with a provider. For example, attorney fees, medical records fees, etc. Invoice charges cannot be reported on the UDS report because there is no encounter associated to an invoice. Unapplied Credits Encounter-level unapplied credits can be used since they can be tied to a provider and location in NextGen® Enterprise PM and can therefore be reported correctly on the UDS report. Account-level unapplied credits should not be used because they cannot be tied to a Provider and Location in NextGen® Enterprise PM and therefore cannot be reported correctly on the UDS Report. To prevent users from entering patient payments as account-level unapplied credits, security access in System Administrator can be setup for the appropriate user groups as follows: Operations > Transactions > Unapplied Account Payment Addition = No Operations > Transactions > Unapplied Encounter Payment Addition = Yes Primary

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

Tracking Qualifying Encounters

Recommendations

Setup for Qualifying Encounters

Qualifying Encounter Report

Service Item Library Maintenance Qualifying Encounter Descriptions

Set Up Qualifying SIMs

Do's and Don'ts for the UDS Report

Encounter Maintenance - Encounter Specifics Tab

Setup for Qualifying Encounters

Qualifying Encounter Report

Service Item Library Maintenance Qualifying Encounter Descriptions

Set Up Qualifying SIMs

Do's and Don'ts for the UDS Report

Encounter Maintenance - Encounter Specifics Tab