The UCSF Office of Healthcare Compliance and Privacyestablishedand maintainsa Revenue Cycle Compliance Program to ensure that the UCSFworkforce has the training and resources needed to perform their duties, reportissues and concerns, and refer questions to our officewhen additional guidance is needed.
Program Scope
The Revenue Cycle Compliance Program (RCC) promotes compliance with applicable laws, regulations, and policies pertaining to billing and reimbursem*nt of professional, hospital, and clinical research activities. Our program is designed to reduce the potential for noncompliance with government and other third party payors by fostering the elements of an effective compliance program across the UCSF healthcare enterprise.
Major Focus Areas
Professional Services
The Professional Services team focuses on compliance with documentation, coding, and billing requirements for professional fee services provided by UCSF Faculty, Advanced Practice Providers, and Affiliates.
Government Audits
The Government Audit teamfacilitates the processing and response to billing and reimbursem*nt-related audits and investigations by Federal and State payors and regulatory agencies.
Hospital Services
The Hospital Services team focuses on compliance with documentation, coding, and billing requirements for hospital services provided by clinical staff at UCSF Medical Center, UCSF Benioff Children's Hospitals and Langley Porter Psychiatric Hospital and Clinics.
Clinical Research Billing
The Clinical Research Billing (CRB)team focuses on compliance with documentation and billing requirements forclinical trials conducted at UCSF. The team works with school and campus departmentsto promote compliancewithfederal and state laws, regulations, and policies.
Examples of Our Activities
- Auditing and monitoring compliance with coding, documentation, billing rules and regulations
- Monitoring the accuracy of diagnosis and procedural coding
- Assessment of themedical necessity of services provided
- Identification ofdeficiencies in documentation
- Education focused on current regulations and audit findings
- Promoting accuratereimbursem*nt to the organization
