Billing Compliance

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Billing Compliance

Mission Statement

The mission of the Compliance Plan for Health Sciences Billing and Patient Services for Creighton University's Health Sciences Schools is to provide adequate resources to faculty, Staff, residents and others involved in patient care activities to ensure proper billing of health care services and items according to federal and private payer requirements. This mission is designed to support the strategic objectives outlined in the Health Sciences Schools' mission statement.

Contact Us

Stuart Martens, J.D.
Director, Intellectual Resource Management (IRM)
Phone: 402-280-3453

T. Paul Tomoser, CPA, CIA, CRMA
Internal Audit Director
Phone: 402-280-3026

Compliance Program

Compliance Policies

Compliance Audit Policies

Payer Manuals and Instructions

Documentation and Coding Resources

Documentation and Coding Resources

Evaluation and Management Documentation Guidelines

Documentation Guidelines

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

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

History Components

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)

1995 Exam Components

PF: One body area/organ system

EPF: 2-7 Body areas/organ systems

D: 2-7 Body areas/organ systems

Teaching Physician Rules and Guidance


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

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

CMS Guidance

11/22/02 Transmittal; Revised Teaching Physician Instructions

Other Information on Teaching Physician Rules

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

Billing Research Related Care

Billing Research Related Care

CMS Medicare Clinical Trials Resources

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 

Billing and Other Resources

Billing and Other Resources