Healthcare Billing Compliance

UTHealth is committed to providing high-quality patient care and to complying with applicable laws and regulations. All claims for professional fee reimbursement made by or on behalf of UTHealth shall adhere to applicable federal and state laws and regulations, The University of Texas System Board of Regents’ Rules and Regulations, and UTHealth policies. The institution will follow all legal and regulatory guidelines for billing hospital and physician services. Any contractors engaged to perform billing or coding services are expected to ensure that all billings for government and commercial insurance programs are accurate. UTHealth shall collect only those amounts to which the institution is entitled and refund amounts billed and/or collected in error. Employees and medical staff members will receive disciplinary action for failure to abide by the applicable federal and state laws and regulations, The University of Texas System Board of Regents’ Rules and Regulations, and UTHealth policies.

Examples of unacceptable billing practices include, but are not limited to:

  • Billing for items or services not accurately documented in the medical record;
  • Billing for items or services that were not actually rendered;
  • Billing for items or services that were not medically necessary; and
  • Duplicate billing.

Questions about a billing compliance practice? Contact Healthcare Billing Compliance.

If you believe any unacceptable billing practices have occurred or have any billing compliance concerns, you should discuss the issue with your supervisor. If you do not feel comfortable discussing the issue with your supervisor, you may contact the Office of Institutional Compliance at (713) 500-3294. You may also contact the Compliance Hotline at 1-888-472-9868.

Institutional Healthcare Billing Compliance Plan

Institutional Healthcare Billing Compliance Plan

Training Schedule:

New Provider Orientation - Tuesdays from 9:30-11:00 AM University Center Tower--Suite 1510  We also have new provider orientation on line at the Training and Resource Center. Please call to schedule class or online training. (713 500-3306)

Resident Training (training scheduled by departments according to lecture schedule)

Specialty Training - scheduled as needed by departments

AAPC - Second Tuesday every month 12-1 PM @ Medical School Building

Healthcare Billing Compliance Policies, Guidelines and Facts:

1995 Documentation Guidelines for E/M Coding

1997 Documentation Guidelines for E/M Coding

2010 CMS Consultation Final Ruling

Advanced Beneficiary Notice for Noncovered Services

CMS Fraud and Abuse Fact Sheet

Coding and Documentation Reference Guide

Complying with Medicare Signature Requirements

Documentation and Signatory Policy

Evaluation and Management (E/M) Services Fact Sheet

Global Surgery Fact Sheet

Guidelines for Teaching Physicians, Interns, and Residents

Guidance on Hospital Inpatient Admission Decisions

False Claim Act and Whistleblower Protections

Medical Service Research and Development Plan (MSRDP) Physicians

Medical Service Research and Development Plan (MSRDP) Non Physician

Modifier Manual

Modifiers for Billing Medicare

Roadmap For Physicians to Avoid Medicare and Medicaid Fraud and Abuse

Routing for Important Correspondence

Scribe Policy

ICD-10 CM and ICD-10 PCS Resources:

ICD-10 An Introduction

ICD-10 Quick Reference

ICD-10 Myths and Facts

ICD-10 CM and ICD-10 PCS Basic Crosswalks

Other Resources:

American Academy of Professional Coders

Centers for Medicare & Medicaid Services

Novitas Solutions Inc

Routing for Important Correspondence

Routing for Important Correspondence