Set Up Charge Options

Help Guide for NextGen® Enterprise PM 8

Set Up Claim Options

The Claim Options tab is used to configure specific parameters that affect claims for Behavioral Health charges. Options to always send unit count as 1 on claim charge lines, and to always send one line item per claim are available. On secondary and tertiary claims, charges can bill as the total sum of the roll-up charges, or as the total sum minus transactions posted from the prior payer. Also, secondary and tertiary claims can be billed as a primary claim depending on the prior payer. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the library. The Behavioral Health Billing Library Maintenance window opens. Select Claim Options. Enter the Claim Options fields to set up the claim options for behavioral health billing. Select OK. Claim Options Field Descriptions You can set up claim options for behavioral health charges. Parent topic: Add or Modify a Behavioral Health Billing Libra

File Maintenance Help for NextGen® Enterprise

Set Up Charge Options

A positive variance or a negative variance occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the library. The Behavioral Health Billing Library Maintenance window opens. Select Charge Options. Enter the Charge Options fields to set up charge options for behavioral health billing. Select OK. Charge Options Field Descriptions You can set up charge options for behavi

Help Guide for NextGen® Enterprise PM 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

File Maintenance Help for NextGen® Enterprise 8

Set Up Charge Options

The Charge Options tab is used to configure a Variance SIM code to be used with Behavioral Health roll-up charges. A variance (positive or negative) occurs when two or more charges roll-up to a single line item on the claim with a unit value that is different from the sum of the unit values on the individual charges. When a variance occurs, a charge is added during the billing process to either increase or decrease the number of units and the balance on the encounter. This ensures that the balance in NextGen® Enterprise PM is the same as the amount billed on the claim for the roll-up charges. Note: Variance charges added in NextGen® Enterprise PM are not sent on claims. Open File Maintenance. Select Libraries, and then Behavioral Health Billing. The Behavioral Health Billing List window opens. Double-click to open the desired library. The Behavioral Health Billing Library Maintenance window opens. Select the Charge Options tab. Complete the fields to set up Charge Options. To save chan

Help Guide for NextGen® Enterprise PM 8

Add or Modify a Behavioral Health Billing Library

A single library can be created and linked to the practice to be used for all payers or a payer-specific libraries can be created and linked only to those payers. Open File Maintenance. Select Libraries, and then select Behavioral Health Billing. The Behavioral Health Billing List window opens. Do one of the following: To create a library, select Open Menu , and then select New. To modify a library, select the library from the list, and then select Open Menu and select Open. The Behavioral Health Billing Library Maintenance window opens. In Behavioral Health Billing Library, enter a name for the library. Enter the Charge Options, Claim Options, and Biling Options parameters. Select OK. 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. Set Up Charge Options You can set up charge options to configure a variance SIM code to be u

Help Guide for NextGen® Enterprise PM 8

Example Negative Variance

In the below example, the individual charge lines total 0.8 units at $80. Roll-up logic will bill 0.7 units at $70 on the claim. Therefore, during the billing process, a "variance" charge will deduct –0.1 unit at –$10 from the encounter. This ensures that the $70 expected reimbursement from insurance can be posted to a $70 balance in NextGen® Enterprise PM. Otherwise, a $70 reimbursement on an $80 balance would leave a balance. Payer Rounding: Exact units to the first decimal place Charge 1 CPT4 / Price: 90862 / $100.00 per unit Base Minutes: 60 Start/Stop Times: 10:00 – 10:21 = 21 minutes Quantity/Units: 0.4 unit Charge Amount: 0.4 unit X $100.00 = $40.00 Charge 2 CPT4 / Price: 90862 / $100.00 per unit Base Minutes: 60 Start/Stop Times: 11:00 – 11:21 = 21 minutes Quantity/Units: 0.4 unit Charge Amount: 0.4 unit X $100.00 = $40.00 Charge Totals: 90862; 0.8 unit; $80.00 Roll-up Totals: 21 minutes + 21 minutes = 42 minutes = 0.7 unit Roll-up Claim: 90862; 0.7 unit; $70.00 Variance: –0.1

Set Up Charge Options

Recommendations

Set Up Claim Options

Set Up Charge Options

Set Up Charge Options

Set Up Charge Options

Add or Modify a Behavioral Health Billing Library

Example Negative Variance

Set Up Claim Options

Set Up Charge Options

Set Up Charge Options

Set Up Charge Options

Add or Modify a Behavioral Health Billing Library

Example Negative Variance