Claims for Professional Fee Reimbursement

Category: Compliance

Date: January 8, 1997

Reviewed/Revised: April 2013

Purpose

The establishment of policy guidelines for proper coding, documentation, and claim submission for professional fee reimbursement.

Policy

It is the policy of the EVMS Medical Group that all claims for professional fee reimbursement use the proper code for the services provided, that the documentation in the medical record supports the code, and that the claim is submitted in the name of the appropriate provider. To guide physicians, other health professionals and billing personnel in meeting this objective, the Compliance Officer shall, with the assistance of legal counsel, review existing policy statements, revise those statements as necessary, and develop any additional statements that seem advisable. EVMS Medical Group policies concerning billing, as those policies may be changed periodically, should be considered an integral part of this Plan.