The Office of Institutional Integrity is committed to maintaining the highest level of integrity as it relates to our billing and reimbursement practices. We provide a downloadable, printable document entitled “Standards for Documenting and Billing Medical Professional Services” (the "ECU Documentation Standards") to serve as a guide for ECU employees who document and code professional medical services. It provides documentation and coding information for surgical services, non-physician providers, other medical and diagnostic services, teaching physician guidelines, as well as documentation for evaluation and management services.
It is expected that every provider at the Brody School of Medicine who bills for services strictly adheres to these standards. Consistent failure to satisfy the requirements set forth in the ECU Documentation Standards may result in disciplinary action, up to and including termination of billing privileges.
As part of our Compliance Program, the Office of Institutional Integrity conducts routine, random prospective reviews of billing claims data from a sample of medical and billing records for a designated period to assess a provider's compliance with established standards of practice for teaching physician documentation, coding and billing. Records are examined for compliance with Medicare, Medicaid, TRICARE, and other third party billing requirements, as well as the ECU Documentation Standards.
Following this review, results are discussed with the applicable provider and coder who may have coded such provider's documentation. At that time, we also provide billing and documentation education to the provider regarding any documentation deficiencies noted, or ideas on how to improve documentation. Any claims that are identified with incomplete or inaccurate documentation are not submitted for payment to any third party payor. Serious or recurrent billing deficiencies may be subject to a specific corrective action plan.
Please call or e-mail the Office of Institutional Integrity to discuss any billing/documentation issue or question. We are here as a resource for you.
If It Concerns You, It Concerns Us
Standards for Documenting and Billing Medical Professional Services