How do I set up Bill Code Rules?

Bill Code Rules are available to all agencies using Billable Item Management and allow users to create rulesets with one or more rules attached. The rules can then be added to bill codes and applied automatically to visits that match the criteria. 

Using Bill Code Rules enhances claim accuracy and payor compliance, and since you only need to set the rules once, it also reduces the need for manual effort. 

Sample use case:

• Given:
  • Visit 1 on October 1, 2024 for Bill Code T1019
  • Visit 2 on October 1, 2024 for Bill Code T1019
• If the modifier rule type "Second Billable Item for the same date, bill code, and payor" is set up with U2, a U2 modifier will be added to the second visit. 

Add a ruleset

1. Go to Accounting > Accounting Settings > Bill Code Rules.

2. Select + Ruleset.

3. Fill out a Name and Description, and choose Type, either Modifier or Occurrence. 

5. Select + Rule.

6. Enter a code and select a rule. The rule types and their supported rules are as follows: 

Rule type	Supported rule
Modifier	Second Billable Item for the same date, bill code, and payor
Modifier	Third Billable Item of the day and beyond for the same date, bill code, and payor
Modifier	Billable Item lasting more than 12 hours but not more than 16
Occurrence	First Billable Item of the day for the same payor

7. If you would like to add more rules to the ruleset, repeat steps 5 and 6.

8. Save.

The new ruleset will now appear on the grid.

Edit a rule set

1. Go to Accounting > Accounting Settings > Bill Code Rules.

2. Select Edit on the ruleset you would like to modify.

3. Make your changes.

• You can reorder the rules by dragging them. 
• Note that you cannot change the rule type. 

4. Save.

Learn more

• How do I add/edit/disable Bill Codes?
• The Relationship between Service Codes, Pay Codes, Bill Codes, and Funders