Billing Compliance

• Compliance Plan for Health Sciences Billing and Patient Services November 2007 [pdf]
• DRA Policy 2009 [pdf]
• 2008 Amendments to Compliance Plan for Health Sciences Billing and Patient Services
• July 2009 Amendments to the Compliance Plan for Health Sciences Billing and Patient Services [pdf]
• December 2009 Amendments to the Compliance Plan for Health Sciences Billing and Patient Services [pdf]
• May 18, 2010 Amendments to the Compliance Plan for Health Sciences Billing and Patient Services [pdf]

• Billing Compliance Committee Members
  Billing Compliance Committee, January 1, 2013 - Members

ADMINISTRATION

BILLING COMPLIANCE

• False Claims Act and Employee Reporting of Noncompliance (2.5.1.)
• Health Record Documentation (2.5.4.)
• Medicare Advance Beneficiary Notice of Non Coverage (2.5.5.)
• Patient Care Unit Compliance Billing Monitoring (2.5.6.)
• Teaching Physician Requirements - EM - Time Based Codes (2.5.2.)
• Teaching Physician Requirements - Surgeries (2.5.3.)
• Waivers of Coinsurance Amounts (2.5.7.)

Department Audit Guidelines (Revised 1/1/12)

Billing Audit Handbook (Revised 1/1/12)

Audit Handbook Appendices A-I (Revised 1/1/12)

Audit Handbook Appendix J (Revised 1/1/12)

Audit Handbook Appendices K-O (Revised 1/1/12)

Corrective Action for Audit Findings (Revised 1/9/12)

Provider/Coder Summary, Scorecard, and Error Corrections

• CMS Manuals & Publications
• J5 A/B MAC (WPS Medicare)
• Nebraska Medicaid (Regulations)
• Iowa Medicaid Physician Manual
• TriCare Manuals (TriWest)

• ICD-9 Codes (New, Revised & Discontinued)
• CMS Annual HCPCS Update Site
• E&M Documentation Guidelines
• Teaching Physician Rules and Guidance
• Non-Physician Provider Materials
  • Nurse Practitioner Payer Grid Oct. 2011
  • Physician Assistant Payer Grid Nov. 2011
  • Non-Physician Provider Comparison Table (Nebraska)(January 2005) [doc]
• Billing Policies and Procedures for the School of Medicine

1995 Documentation Guidelines: [Word] [PDF]
1997 Documentation Guidelines: [Word] [PDF]

Office New Patient

Level	History	Exam (95)	Exam (97)	MDM
99201	Problem Focused (PF)	Problem Focused (PF)	Problem Focused (PF)	Straightforward (SF)
99202	Expanded Problem Focused (EPF)	Expanded Problem Focused (EPF)	Expanded Problem Focused (EPF)	Straightforward(SF)/Low Complexity (LC)
99203	Detailed (D)	Detailed (D)	Detailed (D)	Low Complexity (LC)
99204	Comprehensive (C)	Comprehensive (C)	Comprehensive (C)	Moderate Complexity (MC)

PF: Brief HPI (1-3 elements)

EPF: Brief HPI (1-3 elements) and Pertinent ROS (1)

D: Extended HPI (4 +); Extended ROS (2-9) and Pertinent PFSH (1)

Extended HPI (4+); Complete ROS (10) and Complement PFSH (3)

PF: One body area/organ system

EPF: 2-7 Body areas/organ systems

D: 2-7 Body areas/organ systems

HCFA (now CMS) Teaching Physician Rules, pg. 63135

Issued: December 8, 1995
Effective: July 1, 1996

11/22/02 Transmittal; Revised Teaching Physician Instructions

Teaching Physician Documentation Examples from November 22, 2002 Transmittal [doc]

CMS Medicare Clinical Trials Resources

http://www.cms.hhs.gov/ClinicalTrialPolicies/

Guidance for Use of Q0 and Q1 Modifiers: [doc]

CU and CUMC Policy on Billing for Research-Related Services

CUMC Cost Sheet and Approval of Research Protocols Form 

• CMS Manuals & Publications
• J5 A/B MAC (WPS Medicare)
• Nebraska Medicaid (Regulations)
• Non-Physician Provider Materials
  
  • Non-Physician Provider Comparison Table (Nebraska)(January 2005) [doc]
• ICD-9 Codes (New, Revised & Discontinued)
• Medicare's National Coverage Decision
• Teaching Physician Rules and Guidance
• E&M Documentation Guidelines
• Risk Assessment & Audit Program [pdf]