Education and Tools

A major focus of the URMC Compliance Program is 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
• Develops tools which assist providers with efficient, effective documentation and accurate billing
• Audits/monitors inpatient and outpatient records for compliance with regulations and appropriate selection of billing level
• Enables employees to report non-compliant activities without fear of retribution. For more information about this program, see the Integrity Helpline web page.

2023 Evaluation & Management Guidelines

Inpatient

Inpatient/Observation E&M Guidelines

Inpatient/Observation Consultation Guidelines

Inpatient & Outpatient Level of Medical Decision Making

Split/Shared Inpatient and Observation Workflow

Split/Shared Visit Modifier FS Guidelines

Outpatient

Outpatient E&M Guidelines

Inpatient & Outpatient Level of Medical Decision Making

Split/Shared Outpatient Workflow

Split/Shared Visit Modifier FS Guidelines

Miscellaneous

Medical Decision Making Definitions & Clarifying Terms

Modifier 25 - E&M on the Same Day as a Procedure

Prolonged Service Codes

Home or Residence E&M Guidelines

Nursing Facility Guidelines

Student Documentation Guidelines