Billing Compliance Policy and Procedure
Chapter 1 - Administration
- 1.0 Policy Development and Implementation
- 1.1 Compliance Record Maintenance
- 1.2 Vision, Mission & Values Statement
- 1.4 Queries Directed to CMS
Chapter 2 - Education
- 2.0 Training, New Provider Orientation
- 2.1 Training, New Resident Orientation
- 2.2 Training, Annual Education
Chapter 3 - Corrective Action
- 3.0 Coding and Documentation Improvement
- 3.1 Report and Return of Overpayments
- 3.3 Documentation Forms
Chapter 4 - Documentation and Billing Standards
- 4.0 Documentation Standards
- 4.1 Teaching Physician Requirements for Evaluation & Management Services, Including Time-Based Codes
- 4.2 Teaching Physician Requirements for Evaluation & Management Services Provided under Medicare’s PCE Rule
Chapter 5 & 6 - Monitoring, Auditing, Investigations and Reporting
- 5.1 Responding to External Billing Audit Requests
- 5.2 Routine Billing Compliance Monitoring
- 5.3 Investigating Compliance Issues
- 5.4 Annual Risk Assessment
- 5.5 Compliance Office and Legal Office: Protocol
- 5.6 Compliance Issue Resolution
- 5.7 Oversight Audit
Chapter 7 & 8 - Electronic Health Records (EHR) and Coding