NextGen Knowledge Center

Set Up for Eligible Number of Patient Days Billing

Mental illness or substance abuse services can be performed outside of a professional medical setting such as a patient’s home, a senior center, or a community services center. You can now bill these services for the number of days the patient is authorized to receive these services from your practice. If a patient is enrolled in the program for the month of January or 31 days. The patient has a crisis and is admitted to an inpatient facility for 10 days. Therefore, the patient is only authorized to receive these services from you for 21 days.

Formula for Billing
  • Days in the Month = 31
  • Days Eligible for Billing = 21 (eligible patient days minus non-eligible patient days)
  • Billed Amount = (21 Days X Daily Rate)
  1. Open File Maintenance.
  2. Select Libraries, and then select Consolidated Services Claim.
    The Consolidated Services Claim List window opens.
  3. Double-click the library.
    The Consolidated Services Claim Library Maintenance window opens.
  4. Select the open menu button.
    The Consolidated Services Claim Maintenance window opens.
  5. Enter the Effective Date, Expiration Date, Description, Add the Valid Payers fields.
  6. Select Claim Consolidation Rules, and then select the open menu button.
  7. Select New.
    The CSC Timespan Rules window opens.
  8. In Length of Timespan, select Consolidate Monthly Claims, and then enter a description for this type of billing..
  9. From the Rollup Encounter Rate Service Line list, select Yes.
  10. From the Encounter Rate SIM Quantity list, select Number of Eligible Days.
  11. From the Encounter Rate Service Line Amount list, select Eligible Patient Days times Original Charge Amount.
  12. Select OK.
Set Up for Eligible Number of Patient Days Billing