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Compliance Audit Services

Background

An effective Compliance Program includes regular internal auditing and monitoring of a broad range of billing, coding, and documentation acivities.  Activities are identified for review through a number of sources including: potential or actual instances of non-compliance reported to the Chief Compliance Officer, Centers for Medicare and Medicaid Services Compliance Program Guidance, and areas of focused review as outlined in the Office of Inspector General's Annual Work Plan.



Process

Click here to read the Overview of Monitoring Methods.



Documentation

Click here for a complete listing of 2008 Physician Documentation Workshops.  Contact Joan Daniel or Tracy Volel for more information.



Coding Corner

What is coding?  Coding is the process of assigning a numeric value to diagnoses, surgical procedures, signs and symptoms, poisoning and adverse effects of drugs, and medical care.

Coding allows health care providers to condense potentially massive amounts of clinical information onto a short claim form.  The claim form, a key part of the revenue cycle, is submitted to insurance companies for payment.

There are two principal types of coding: diagnosis coding and procedure coding.  Diagnosis coding systems report why the patient received health care services.  Procedure coding systems describe what services and items the patient received. 

Coding systems currently used in the United States are ICD-9-CM, CPT-4, and HCPCS.  For more detailed information about these coding systems, please contact that OMCC.


The Complexity of ICD-9-CM Coding
ICD-9-CM (The International Classification of Diseases, Ninth Revision, Clinical Modification) is the medical classification system used for the gathering of information regarding disease and injury.  It consists of three volumes: (Volume 1) the Tabular List of Diseases and Injuries; (Volume 2) Alphabetic Index of Diseases and Injuries; and (Volume 3) Tabular List and Alphabetic Index of Procedures.  For physician coding, only Volumes 1 and 2 are used.  For hospital coding, all volumes are used.  It is important for those who utilize this classification system to understand the basic principles...

Office of Medical Center Compliance
The University of Chicago Medical Center | 5841 South Maryland Avenue | Chicago, IL 60637
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