Service Code Grouping

NextGen Behavioral Health Suite Help 5.5

Configure Service Code Mapping

The fields across the top of the Service Code Mapping panel correspond directly with the data grid. For service code mapping, you must fill all the fields except Practice, Program, and Location. Open NextGen® Enterprise EHR. Select File > System \ Practice Template. The Select Template window opens and displays the system-related templates. Select the Practice tab, and then select All to display all the practice templates. Select BH Foundation Configuration, and then select OK. In the BH Foundation Configuration template, expand the Service Code Mapping panel. Service Code Mapping panel displaying the list of configured codes To map a code to a specific practice, select a practice. Note: If the code you are mapping is not practice-specific, leave this field blank. To map a code to a specific contract or payer, select Contract/Payer, and then select the payer or contract. Note: The displayed list pulls data from either the Contract library or the Payers master file in File Maintenance.

NextGen Behavioral Health Suite Help 5.5

Service Code Mapping

Service code mapping is a core component of Behavioral Health billing on BH templates for version 3.5 and above. Service codes can be mapped by practice, billing contract or payer, location, and program, credentials, templates, and threshold durations. This mapping promotes cleaner billing on the front end by limiting staff to only the approved codes for their credential level, location, or program. Since codes can be mapped to individual BH templates, this gives you the added ability to map only those codes appropriate for a workflow. For example, the Progress Note template may only have codes mapped to it that are appropriate for this type of activity and then can be further limited by the credential level of the staff member completing the template. The fields across the top of the Service Code Mapping panel correspond directly with the data grid below it. For example, when you select the field directly above the Practice column, the Practice picklist appears. The Practice, Program,

Help Guide for NextGen® Enterprise PM 8

Tracking Qualifying Encounters

Health Centers must track and report qualifying encounters because it helps in determining their per diem rate for the following calendar year. The Qualifying Encounter flag on the Claims tab of the Encounter Maintenance window in NextGen® Enterprise PM is used to assist Health Centers in determining the total number of qualifying encounters that can be reported on their UDS report. Qualifying encounters are tracked in NextGen® Enterprise PM based on setup of SIM codes in the Service Items library. Each SIM code is flagged as either a qualifying service (e.g. office visits, office procedures, outpatient surgery) or a non-qualifying service (for example, lab tests, injections). When at least one qualifying service is entered as a charge on an encounter, the Qualifying Encounter check box is automatically selected when the encounter goes through the billing process. The encounter is then counted as a qualifying encounter on reports. The Qualifying Encounter check box can be manually over

Help Guide for NextGen® Enterprise PM 8

Create a Group Encounter for a Patient Group

You can use this procedure to create a group encounter for all members in a patient group. An encounter is created for each member in the group and you can manually link the encounter to each patient's appointment during the check-in process. Open NextGen® Enterprise PM. From Tasks, select Create Group Encounter. The Add Group Encounter window opens. In the Patient Group field, do one of the following. This field is required. To create the group encounter for an existing patient group, select the group from the drop-down list. To create the group encounter for a new patient group, select Open Menu and then select New Group. To create the group encounter for an existing patient group that needs modifications, select the group from the drop-down list, and then select Open Menu and select Open Existing Group. Note: In the Practice Preference window, on Encounters practice preference, the Default previous payer(s) to encounters created in PM option is selected by default. If you clear this

NextGen Behavioral Health Suite Help 5.5

Submit Charges

Before you begin Service codes, units, and duration are configured on the Service Code Mapping panel in the BH Foundation Configuration template. If any of these fields are blank, the selected code may not be configured correctly. Your practice administrator must review the configuration. For more information, go to NextGen Healthcare Success Community and download the Configuration Guide for NextGen® Behavioral Health Suite. Open NextGen® Enterprise EHR, and then in Patient History, select Open Templates. The Select Template window opens. On the Medical Records tab, select All. Open the billing template, expand the Charges panel, and then enter the start and end times. Note: If the end time is earlier than the start time, or the duration is more than 12 hours, a message appears to correct the entries. In Service Code, select a procedure service code. Depending on the service code selected, the Units field appears. Note: The billing codes are cleared from the fields when you leave the

NextGen® Adaptive Content Engine Help Enterprise 8

Determining the Correct Service Code

Determining the Correct Service Code Determining the Correct Service Code In run time, the stored procedure associated with the Service Code Mapping template runs when the Service performed by check box is selected in the Behavioral health billing section. The system performs one or more of the following actions based on the information documented in the encounter and the code's configuration on the Service Code Mapping system template: Populates the Service description and Service code fields Displays an alert if an E&M code or any additional code is required Launches the Bh Coding Select template if multiple codes are returned Sends start/stop times to the procedure module for codes configured as a time based Once the charges are submitted to the Superbill module, the service code information is sent to NextGen® Enterprise PM. NextGen Enterprise PM uses the submitted data to determine if the total of the duration times can be rolled up into a single line item charge. Templates with t

Service Code Grouping

Recommendations

Configure Service Code Mapping

Service Code Mapping

Tracking Qualifying Encounters

Create a Group Encounter for a Patient Group

Submit Charges

Determining the Correct Service Code

Configure Service Code Mapping

Service Code Mapping

Tracking Qualifying Encounters

Create a Group Encounter for a Patient Group

Submit Charges

Determining the Correct Service Code