Professional Billing Compliance and Audit Training Program

The UCLA Faculty Practice Group requires all new UCLA clinical faculty, volunteer clinical faculty, staff physicians and allied health professionals to successfully complete the UCLA Health System's "Professional Billing Compliance Training Program" ("Training Program") and demonstrate an understanding of the principles, laws and regulations governing payment of claims for Professional Services.  New Providers are required to complete the following steps within the periods specified:

• First Step: Successful completion of the Online Coding Training Modules (available in our learning management system, Cornerstone). Each provider has 30 days from assignment to complete the modules. In addition, every new provider must complete Privacy and Security Training and Code of Conduct, Compliance and Ethics Training.

• Second Step: Successful completion of an Initial Audit by the Physician Billing Office (PBO), Audit Training Unit (ATU).  This audit is triggered upon the Provider's completion of the Online Coding Training Modules.  A Provider is considered to have successfully completed the Training Program if written documentation supports the claims.  Providers who fail to successfully complete must attend additional coding training and are subject to further auditing.

• Consequences of Not Successfully Completing Training Program:  If a Provider fails to successfully complete an audit after a second round of training, all charges submitted for billing are place on hold and are not billed until the Provider can demonstrate compliance in accordance with the Faculty Practice Group's "Standards and Guidelines" for Compliance and Billing and the Provider's Department requirements.

• Continuous Audit & Monitoring for Established Providers:  OCS and PBO will continue to provide ongoing audit and monitoring activity to Faculty Practice Group Providers in an effort to ensure compliance with documentation standards and regulatory guidelines. Faculty Practice Group Providers should expect to participate in periodic audits and education throughout the course of their tenure.

The UCLA Professional Compliance Department is committed to support you with documentation, coding and billing questions and other compliance concerns.  If you have any questions regarding the process, please contact either your Department CAO, or Sarah A. Johnson at [email protected] or (310) 267-2757.

Online Coding Training Modules:

• Introduction to Physician Billing Compliance Program
• Module 1 - Principles of Documentation
• Module 2 - Evaluation and Management Services
• Module 3 - Requirements for Billing for Teaching Physician Services
• Appendix I to EM Module
• Appendix II to EM Module
• Appendix III to EM Module

 

Guidelines:

• Non-Physician Practitioner Guidelines
• Neurosurgery E&M
• Ophthalmology
• Radiology

Physical Examinations:

• Cardiovascular Single System Examination
• Ear, Nose and Throat Single System Examination
• Eye Single System Examination
• General Multiple System Examination
• Genitourinary Single System Examination
• Hematology/Lymphatic/Immunology Single System Examination
• Musculoskeletal Single System Examination
• Neurological Single System Examination  
• Pediatrics General Multi-System Examination
• Psychiatric Single System Examination 
• Skin Single System Examination
   

Current Faculty and Provider Billing Compliance Training

Current faculty and providers associated with UCLA can review helpful information online, according to their department/division, located on the links above. If the physician or provider prefers to request a refresher course with an instructor, the course can be scheduled by contacting Mia Gutierrez at [email protected] or (310) 794-6763.