Billing and Coding Compliance focuses on auditing and monitoring for appropriate clinical documentation and medical necessity for the services provided to our patients. This team also ensures compliance with all applicable Federal and State Laws, regulations and policies that guide billing and coding.
If you are a patient and have questions regarding billing and insurance information, please visit UC San Diego's Patient Guide. Professional Fee Billing Hospital Billing. Clinical Fellow Policy At UCSD, physician trainees who have completed residency training and enroll in subsequent programs leading to a certificate of special competence in a specific medical subspecialty are referred to as "clinical fellows". General Policies and Procedures The following policies and procedures are to be used at this institution when documenting professional services.
Documentation Medical record documentation is required to record pertinent facts, findings, and observations about an individual's health history including past and present illnesses, examinations, tests, treatments, and outcomes. The record should chronologically document the care of the patient, and is an important element contributing to the quality of care.
Medical record documentation should be completed immediately following patient services or within sufficient time to recollect the key portions of the services provided.
Whoever dictates a note, report, or entry, shall sign that note, report, or entry. A medical record is considered a legal document. Teaching physicians may use a macro, a command in a computer or dictation applications in an electronic medical record that automatically generates predetermined text that is not edited by the user, as the required personal documentation, if the teaching physician personally adds it in a secured or password protected system.
The note in the electronic medical record must sufficiently describe the patient specific services furnished to the specific data. If both the resident and the teaching physician use only macros, this is considered insufficient documentation by Medicare. UCSD Medical Group billing records for professional fee services shall be retained for a minimum of 10 years.
Signatures Either the full physician signature, or the first initial of the physician and a complete physician last name is required. Practitioners using a computerized signature to authenticate entries must sign a statement they alone will use it. Whoever dictates a note, report, or entry, shall sign that note, report, or entry — including residents and clinical fellows.
Billing Codes CPT codes. CPT codes range from through Category 1: Procedures and contemporaneous medical practices that are widely performed. Category 2: Clinical Laboratory Services, supplementary tracking codes that are used for performance measures.
Use of this code set is optional and not a substitute for Category 1 codes. Category 3: Emerging technologies, services, and procedures temporary codes. ICD codes. HCPCS codes. Level II of the HCPCS is a standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT-4 codes, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies DMEPOS when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment that are not identified by CPT-4 codes, the level II HCPCS codes were established for submitting claims for these items.
Modifier codes. Certain modifiers indicate that a service or procedure that was performed has been altered in some manner. Utilizing the above coding systems, the UCSD Health is committed to submitting only compliant bills for professional fee services; and further, strives to provide reasonable assurance concerning compliance with conditions of payment and encounter data reporting under managed care plans.
Refunds and Fines As is current practice, amounts identified as a result of inaccurate billing are to be reported and returned as soon as possible — and no later than 60 days from the date that an over-payment is identified through a reasonable and diligence period has concluded. Payment for Attending Physician Services in Teaching Settings Medicare pays for services furnished in teaching settings if the services are: Personally furnished by a physician who is not a resident; or Furnished by a resident when a teaching physician is physically present during the critical or key portions of the service; or Furnished by a resident under a primary care exception within an approved Graduate Medical Education GME Program.
Modifier GC indicates services provided in part by a resident under the direction of a teaching physician. And if your practice does not have a robust denial management strategy and protocol, claims such as this may be simply resubmitted erroneously or even written off entirely.
Inaccurate information can harm the patient and can harm the quality and accuracy of future care. It is irresponsible to put patient health at risk because of something like inaccurate coding.
When your practice is compliant with all medical coding protocol, it is much easier to ensure that billing to patients and insurance is accurate. Accurate billing allows your practice to forecast for the future. Your medical practice will be able to analyze accurate data on revenue, costs, write offs, et al giving your practice the ability to make informant decisions about your business and prepare your practice for financial success in the future.
Accurate billing will help with making important business decisions that may involve staffing, patient outreach, and adding service lines to your practice. Now that you know how important it is to have accurate and compliant billing and coding within your practice, you are probably wondering how to improve your current system. If your practice is struggling to reach compliance and fear you are not capturing the maxim reimbursement, the best possible solution is to hire a third party for revenue cycle management.
Revenue cycle management improves the efficiency, accuracy, and reimbursements for medical practices. At Healthcare Information Services HIS our experts can take over the entire revenue cycle management process to take the burden off of our clients. Reliable revenue cycle management services improve practice efficiency and compliance, allowing your team to focus on providing superior medical care. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website.
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