Education & Tools - Billing Compliance

With the emphasis the Federal Government is placing on uncovering fraud and abuse in the healthcare industry, the Strong Health Compliance Office is focused on developing a program to support effective documentation and accurate billing for physician/provider services. Specifically, the Compliance Office

• Educates providers and billing personnel about regulations for teaching physicians and documentation/billing for E&M services and clinical procedures

• Audits/monitors inpatient and outpatient records for compliance with regulations and appropriate selection of billing level

• Develops tools (such as physical examination templates and E&M Documentation Guideline Cards) which assist providers to efficiently document and accurately bill

• Enables employees to report non-compliant activities without fear of retribution. For more information about this program, see the Integrity Hot Line web page.

Educational Materials

• False Claims Act Prevention
• CMS Compliance Rules for Supervising Physicians in Teaching Settings

Tools

• E&M Documentation Cards
• 1995 E&M Documentation Guidelines
• 1997 E&M Documentation Guidelines
• E&M Elements
• CMS Teaching Physician Guidelines
• Medicare - Supervising Physicians in Teaching Settings
• Medicare - Primary Care Exception Teaching Rules
• Teaching Physician Guidelines for Surgical Procedures
• Basic Tenets of Billing Compliance
• Laboratory Ordering and Coding Guidelines

If you have any questions about any of our services, please call the Compliance Office at 275-1609.

For more information regarding compliance, send email to compliance@urmc.rochester.edu.