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 ‘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 roll-up charge price is then calculated by multiplying the units by the unit price defined for the SIM code.

  Units X Price = Extended Price

The example below illustrates a difference, or variance, between the units and price calculated for each charge during charge posting, and the units and price calculated during billing for the roll-up charge on the claim. For more information on variances, see Behavioral Health Billing Library.