WebbannersHRsite1506296

Billing Compliance

The UC Irvine Health Compliance and Privacy Office provides guidance and policies to promote billing processes that comply with all applicable laws and regulations.

View our policies regarding hospital, professional and research billing:

It is the mission of our Hospital Billing Compliance program to integrate compliance as a fundamental part of the business and clinical operations of UC Irvine Health, with the goal of minimizing organizational risk and reducing hospital system vulnerability for fraud and abuse.

The quality of care provided to patients has become an increased focus of governmental scrutiny; therefore, the accurate reporting of quality-of-care measures has become more important to healthcare facilities.

The compliance program aims to integrate and enhance the compliance activities that are already integral to hospital departments and clinics to ensure applicable regulations, laws and standards are met, and that specific risk areas are addressed.

Our objectives are designed to:

  • Enhance education and training programs relating to the complex rules and regulations impacting hospitals
  • Conduct monitoring and auditing activities for the purpose of identifying potentially troublesome issues, monitor implementation of corrective and preventative actions, and foster effective interdepartmental communication on common compliance issues
  • Assess existing policies and procedures that address potential risk areas

Our areas of focus are:

  • Inpatient and outpatient facility coding and billing for the hospitals and hospital-based clinics
  • Quality-of-care reporting
  • Charge master review
  • Emergency Medical Treatment and Active Labor Act (EMTALA)
  • Medical necessity
  • Provider-based outpatient facilities designations

Guidance & Policies

Resources

It is the mission of our Professional Billing Compliance program to ensure that all UC Irvine Health physicians document their services according to federal and state guidelines, and that documentation supports the services and quality of care provided to patients.

The objectives of the professional billing compliance program goals are to:

  • Enhance education and training programs for physicians, NPP’s, residents, medical students and coding staff
  • Conduct monitoring and auditing activities according to federal and state guidelines of potential high-risk areas identified by the Office of the Inspector General and various other programs
  • Ensure that only the services that are provided are billed to the appropriate third party payer, accurately documented and medically necessary

Our areas of focus are:

  • Inpatient and outpatient physician services
  • All physician’s practices
  • UC Irvine Health Douglas Hospital emergency room
  • Radiology services
  • Pathology professional services

View University of California Professional Billing Program guidelines ›

Developing a Plan

Teaching Physician Guidelines

Policies & Procedures

Resources

Current audit tools:

Helpful links:

The clinical research billing compliance program goals are to:

  • Provide an internal mechanism for quality assurance, quality improvement and education, pursuant to regulations governing research financial compliance, research revenue integrity and research coordinators
  • Conduct monitoring and auditing activities according to all institutional policies and federal and state laws and regulations of potential high-risk protocols defined as high volume of clinical services or mixture of services billed to the study and services billed to the third party payers
  • Ensure that only the clinical research claims that are provided are: billed to the right payer, accurately documented and medically necessary

Guidance & Policies

Resources

Compliance Tips

View our latest tip sheets ›

(password protected)