> ## Documentation Index
> Fetch the complete documentation index at: https://handbook.helendelovely.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Billing Basics for Clinicians

> What a clean claim needs from you, and what you never do.

You don't do billing. The front office and the practice manager do. But every claim starts with your documentation, and a claim is only as good as the note behind it. Here's what they need from you.

## What a clean claim needs

* **A completed note** for the session, within the timing standard in [Documentation standards](/clinical-practice/documentation-standards). No note, no claim.
* **The correct service code** for what you did (for example, individual psychotherapy at the right duration). Use the codes in the PracticeOS note template. If you're unsure which applies, ask Helen.
* **Actual session time**, start and end. Codes are duration-based. Document the real time.
* **A diagnosis** in the record that supports the service. Payers require it. It should be your clinical diagnosis, documented in the assessment.
* **Modality and place of service**: in-person or telehealth, and client location for telehealth.
* **Your credential and NPI**, which the system attaches, as long as your profile is complete.

## How clients pay

Most clients are private-pay at the practice's posted rates, with membership pricing available. Many receive superbills to submit to their own insurance for out-of-network reimbursement. Some payer relationships are in development. The front office knows the current status of each; don't tell a client their insurance will cover you unless the front office or practice manager has confirmed it.

## What you never do

* Document a session that didn't happen, or bill for one
* Round session time up to reach a higher code
* Choose a code or diagnosis for reimbursement rather than accuracy
* Alter a note after a claim is submitted, except by a dated addendum
* Discuss fees, discounts, or write-offs with a client on your own. Route to the front office; Helen decides.

Billing for federal healthcare programs (Medicaid) makes accuracy a legal matter as well as an ethical one. The False Claims Act reaches individuals who knowingly submit or cause a false claim. We're far too small for the law that requires a formal written policy on this, but the underlying rule applies to everyone, and this page is our statement of it.

## If you think something is wrong

If you notice a billing error, a claim you don't recognize, or anything that looks like a compliance problem, tell the practice manager. If you're uncomfortable raising it with her, tell Helen. You won't be retaliated against for raising a good-faith billing concern.

## Questions clients ask you

"How much is this?" "Does my insurance cover it?" "Can I get a discount?" All of these go to the front office. "Let me have the front office follow up with you today" is a complete answer.

## Related SOPs

SOP 09 (payment and insurance info), SOP 14 (eligibility checks), SOP 17 (billing triage), SOP 26 (invoices). See the [SOP library](/operations/sop-library).