Faculty and Staff: For Your Benefit

Medical Compliance Tips for September 2015

Physician Billing Compliance Tip

Remember: More volume of documentation is not always better in the medical record, especially in the Electronic Medical Record (EMR) with potential for cutting/pasting, copy forward, pre-defined templates and pre-defined E/M fields. Ensure the billed code is reflective of the actual service provided on the date of service (DOS) only.

Hospital Billing Compliance Tip

The use of an FDA-approved drug or biological is covered if:

• It was administered on or after the date of the FDA’s approval.

• It is reasonable and necessary for the individual patient.

• All other applicable coverage requirements are met.

Research Billing Compliance Tip

Proper Claims for Clinical Trials

Avoid submitting improper claims related to clinical research by:

1. Pre-determining who is responsible for payment for item/service by performing a coverage analysis,

2. Identifying patients as research participants when scheduling research-related inpatient admissions, outpatient clinic visits, and office visits for treatment or evaluations,

3. Reviewing all study-related charge posting and claims to ensure services are billed to the proper payor,

4. Assuring the service has not been billed to or paid by both the study account and an insurance account.

More Billing Compliance Tips can be found at www.obc.med.miami.edu