How Billing Rules Work

Clinicient Insight is designed to aggregate procedure codes based upon clinical documentation. Put another way, the therapist's job is to do good clinical documentation by accurately documenting the clinical services provided and the time that the visit started and ended. The system automatically generates the correct procedure codes and submits those codes for billing. The procedure code generation is based upon:

  • The procedure code (CPT Code) associated with the clinical service provided,
  • The documented number of minutes spent on each service,
  • The documented length of the visit,
  • Whether the associated procedure code is timed or untimed, and
  • Any special billing rules that are in effect for the patient's insurance plan.

Billing Rules

Any number of billing rules may be created in the system, and those rules may be applied to multiple insurance plans. The CCI edits for Medicare are an example of a specific billing rule set. (The CCI rule set is already included with Insight.)

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