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Billing Compliance Policies

The Billing Compliance Policies affirm UW Medicine’s commitment to performing billing activities for clinical, research and professional services in full compliance with State and Federal billing regulations.

COMP.201 Fraud, Waste and Abuse Prevention 

This policy provides information as to the laws prohibiting false claims for reimbursement by government health care programs and the UW Medicine activities to comply with those laws.

COMP.202 Budgeting and Billing Requirements for Clinical Research 

The purpose of this policy is to identify when clinical research studies require pre-implementation review by the UW Medicine Clinical Research Budget and Billing Office-Clinical Trials Office (CRBB-CTO), and to establish standards for accurate budgeting, billing and documentation related to services that accompany clinical research.

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COMP.203 Billing Based on Timely Documentation of Ambulatory Care Clinic Visits 

This policy establishes clear direction for billing based on the creation of medical records for ambulatory care clinic encounters. Separate UW Medicine or entity policies/bylaws establish the time within which providers are required to complete documentation of an ambulatory care clinic visit. This policy establishes billing requirements to follow in the event that a provider does not meet the documentation timeline requirements applicable to the service to be billed.

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COMP.204 Identifying, Reporting, and Returning Overpayments Related to Government Reimbursement 

This policy sets forth a framework for UW Medicine entities to identify, report and return overpayments. This policy applies to all healthcare services for which UW Medicine has submitted a claim and received payments from a government source, such as a federal healthcare program, or if a government source funded any portion of the payment received.

COMP.205 Charge Waivers and Discounts 

The purpose of this policy is to define when charge waivers and/or discounts may be applied to patient accounts and balances for UW Medicine healthcare services in a way that ensures compliance with health care regulations, commercial payer contracts, and financial assistance standards in accordance with the UW Medicine Financial Assistance Policy.

This policy is applicable to all UW Medicine entities except UW Physicians (UWP) and pertains to non-UWP professional and/or hospital charges submitted by the entity. UWP has its own policy addressing these matters which was adopted by the UWP Board of Trustees in November 2010, and is congruous with this policy.

UW Physicians Professional Billing Compliance Policies [requires AMC login]

The professional billing compliance policies are designed to ensure billing and reimbursement practices for professional services align with highest standards of ethical behavior and regulatory compliance.