Hospital Billing Policy (2.12)

Hospital Billing Policy (2.12) - Policies, Administrative, UWHC, UWHC-wide, Fiscal


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Administrative (Non-Clinical) Policy
As of June 1, 2016, this administrative policy applies to the operations and staff of legacy
UWHC. Effective July 1, 2015, the legacy operations and staff of UWHC and UWMF were integrated
into the University of Wisconsin Hospitals and Clinics Authority (UWHCA). All administrative policies
are being transitioned to apply UWHCA-wide, but until future revision to this policy #2.12, it applies
only to the operations and staff of legacy UWHC.

Policy Title: Hospital Billing Policy
Policy Number: 2.12
Effective Date: June 1, 2016
Chapter: Fiscal
Version: Revision

To establish a billing policy for patients who receive services. To assure that without exception charges
for services at University of Wisconsin Hospitals and Clinics (UWHC) are posted to an account and to
assure that these charges are applied in a timely and consistent manner.


Charges must be submitted for all Hospital services. This includes any and all charges for a patient's care
and treatment. Charges must be generated for all patients who receive services including UWHC
employees and medical staff. Under all circumstances charges must be applied to an account.


Appropriate departmental source documents and reconciliation documents (e.g., appointment logs, daily
activity journal).

A. Every patient who receives services must first be admitted or registered and must have an
encounter created with the Hospital Account Record (HAR) attached.
1. All inpatients must be registered according to Admissions Department procedures.
2. All outpatients must be registered in accordance with Outpatient Registration procedures.
B. Charges for services must be processed within 1 business day. This applies to all charges:
inpatient, outpatient and groups. Credits must be submitted within 1 business day of knowledge
of an inappropriate or incorrect charge. Any exception to this timeliness provision requires prior
approval from UWHC Patient Business Services. Whether charges are entered directly into the
information system or via a foreign system interface (e.g. lab, pharmacy) or through batch mode
submission, the following requirements must be met:
1. The service date must reflect the date the service was actually performed. In the case of
laboratory specimens, the service date must equal the specimen collection date. The
service date for credits must reflect the date of the original charge.

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2. The quantity must always reflect the correct unit of measure used for pricing, e.g.
minutes, quarter-hours, boxes, etc.
3. Miscellaneous charge codes in ancillary systems are to be used only when a specific
charge code does not exist. An accurate but brief description and a price are always
required for miscellaneous charge codes.
4. Charges provided to inpatients must be applied to the inpatient account irrespective of the
service site, e.g. an outpatient clinic visit by an inpatient must be applied to the inpatient
5. Reconciliation of charge and credit posting, via the Daily Activity Journal (DAJ) or the
Enterprise Encounter Reconciliation Report (ERR), must be performed within 1 business
day of submission to verify accuracy of posting for all services provided. Reconciliation
procedures must assure:
a. Using the DAJ or ERR, that all charges or credits submitted posted successfully
b. Using internal source documents (e.g. the Health Link Department Appointment
Report (DAR), Health Link Admissions, Discharge, Transfer (ADT) reports,
appointment books, etc) that charges were submitted for all services.
6. Charges trapped in the Health Link Charge Review work queue assigned to each revenue
generating department must be resolved/corrected by the department within 1 business
day. The manager, or their delegate, must identify the reason for the item being in the
work queue and then notify the appropriate clinician to complete or adjust the
documentation, or contact the charge master so a new charge can be created and the
procedure can be added to the preference list. It is the responsibility of the manager or
delegate to perform the appropriate follow-up to ensure the charge is removed from the
work queue. If the issue cannot be resolved by the department, the issue must be
communicated to the UW Health Information Services Help Desk (via Service Now
request) within 1 day.
7. Revenue center managers are required to monitor their Revenue and Usage report and the
Late Charges report on a monthly basis to identify any discrepancies or unexpected
swings in revenue that may be the result of a charge capture problem.
C. Documents used to record charges or credits must contain all information necessary to process a
charge. The following are required on all charge documents:
1. Patient Name
2. Patient Medical Record Number and Account Number
3. Date of Service
4. EPIC Accounts Receivable Procedure (EAP) Code and Quantity
5. Credit requests require the reason for the credit and the name of the manager approving
the credit.
D. Patients who have or are perceived to have insufficient financial resources to meet charges should
be referred to a Patient Account Representative (Room # H6/220 or phone the business office at
608-262-2221, whichever is appropriate).
E. For accounting and budget purposes, it is imperative that charges be applied for all services.
Departments do not have the authority to waive application of a charge for any reason.
Mechanisms exist within Fiscal Affairs to address those rare circumstances when a charge should
not be billed.
1. Patients should be referred by clinical staff to the Patient Account Representative Office
at H6/220. The Patient Account Representative will obtain the information necessary to
determine the appropriate resolution of the account.

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Sr. Management Sponsor: CFO
Author: VP, Revenue Cycle; Director, Internal Audit

Approval Committee: UW Health Administrative Policy & Procedure Committee


Ronald Sliwinski
President, University of Wisconsin Hospitals
Chief of Clinical Operations

Revision Detail:

Previous revision: 062013
Next revision: 062019