UW Medicine Compliance

Billing Policies

201 Fraud, Waste and Abuse Prevention

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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.

This policy is applicable to all UW Medicine entities.

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202 Budgeting and Billing Requirements for Clinical Research

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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.

This policy applies to the following:

  • All clinical research studies utilizing services, items or tests furnished by a provider who bills through UW Physicians, regardless of the site of practice;
  • All clinical research studies (e.g., clinical trials and Medicare-approved registries) that involve services, items or tests provided by a facility that bills through UW Medicine Patient Financial Services (PFS), or CRBB-CTO, whether the services are billed to study subjects, study budgets or both. See 202.G1 Billing Entity by Site of Practice.

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203 Billing Based on Timely Documentation of Ambulatory Care Clinic Visits

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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.

This policy is applicable to all UW Medicine entities.

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204 Identifying, Reporting and Returning Overpayments Related to Government Reimbursement

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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.

This policy does not apply to routine processing errors. Routine processing errors should be corrected by the individual who detects the error by following applicable entity procedures for reconciling such errors.

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205 Charge Waivers and Discounts

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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 facility 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.

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