Center for Eye Care

Patient Billing Compliance Policy

The standard for billing patient services requires Center billing staff to review and evaluate the completed medical record prior to the submission of any charges. While billing practices for patient services vary, the prevailing standard in most physician offices and clinics is to ask for payment at the time the services are rendered or to submit a bill to the patient's carrier at the end of the day. It is not practical to expect every patient record to be 100 percent complete when the patient leaves the Center.

Based on questions the Compliance Director has received, it was apparent that Center billing staff would benefit from some standardized advice with respect to patient billing. The following additional instructions are to be used in conjunction with existing guidelines and regulations for professional billing:

1) Completed attending notes will be in the patient medical record within three working days of the patient encounter.

2) Center staff may submit professional charges for non-procedural clinic encounters before a complete written attending note is in the record as long as:

a. there is sufficient evidence in the record that a billable patient encounter occurred,

b. the billing attending has provided a clinical diagnosis and treatment plan, and

c. the billing attending has chosen a level of patient encounter that the staff feels is likely to be supported by the clinical diagnosis and plan.

3) Center staff may only submit professional charges for patient procedures on the basis of a recorded description of the procedure in the medical record. For purposes of Part B billing, the note must be authored by the provider who performs the procedure and conforms to current documentation requirements.

4) The Department Assistant for Quality Assurance will perform periodic random reviews to be certain all documentation is completed within the three business days allowed above.