UVA Community Health Intranet UVA Community Health Intranet
UVA Health logo

Billing & Coding Compliance

Billing & Coding Compliance

 

Our clinical teams embody our Commitment to Excellence in caring for our patients by providing safe, high-quality care, and documenting the work they do in the patient’s medical record. Coding then uses this documentation to assign codes for the services, procedures, and diagnoses that are supported in the medical record for billing. These codes are submitted on claims to insurance companies and patients for payment. Billing handles the submission of claims, confirming claims are processed appropriately, verifying payments received are correct, and addressing any denials for services by insurance companies through the appeals process.  UVA Community Health Billing & Coding Compliance works in partnership with the UVA Health Corporate Compliance office, Revenue Cycle and others to ensure we are in compliance with federal, state, and other regulations for medical billing and coding. Errors in billing and coding can have serious consequences, and issues related to billing, coding, and reimbursement are highly complex and heavily regulated.

 

How do we do this, you ask? 

Billing & Coding Compliance makes sure we are in compliance with billing and coding regulations and guidelines through:

  • Investigations – audits and reviews relating to a reported concern(s)
  • Compliance Risk Assessment – audits of items identified on our Annual Compliance Risk Assessment  
  • OIG Workplan – audits of items the government (OIG) has flagged as areas they will be focusing their audits on
  • Proactive Audits – a review to evaluate our processes and practices to make sure we are in alignment with current guidelines and regulations
  • Guidance Interpretation – providing guidance on interpretation of regulations and coding guidelines
  • Implementing Corrective Actions – this could be addressing systems errors, educating staff members, and taking action to correct overpayments and underpayments
  • Protective Actions – If an error or issue is found, work with teams to put safeguards in place to prevent similar errors in the future

 

How can you help?

Examples of Billing & Coding Issues That Must Be Reported

Team members should report any concerns or suspected issues related to improper billing or coding practices, such as, but not limited to:

  • Upcoding or down-coding a service
  • Billing for items or services that are not reasonable and necessary
  • Billing for items or services that are not rendered
  • Improper documentation
  • Unbundling (billing separately for services that should be reported with one code)

 

When in doubt, reach out!

 

Report Billing & Coding Compliance concerns to:

Compliance QR

Create Profile

Account Information (*Required)
Contact Information
Edited by: Dana Richardson (dr4gz) Updated: October 30, 2025