This guide outlines the Physicians' Billing Office (PBO) policies and procedures framework and its development, approval, implementation and maintenance processes.
The Faculty Practice Group (FPG) has formed a PBO policy committee, which meets on a regular basis to initiate policy development. Members of the committee consist of FPG quality development staff, Director of Physicians' Billing Office and FPG Chief Operating Officer.
Other management staff from ambulatory operations, managed care contracting, PBO and information technology may be responsible for assisting in policy development, review and implementation. As appropriate, department heads may review and sign off on draft policies.
Policies developed by PBO representative units other than the committee are presented to the committee for review before being routed for final approval. This ensures consistency in written format, legality, content, publication and distribution protocols and proper prioritization in the final approval process.
The committee takes all or some of the following steps prior to developing a new policy:
Once all available data is collected and analyzed the committee issues a draft policy recommendation.
Below are some pivotal policy drivers providing the framework in which PBO policies are developed.
All approved policies are filed in the official PBO policies manual.
Each PBO unit is provided one hard copy of the manual. Unit managers will periodically receive new policies to be added to the manual, as well as revised policies to replace previous versions. It is recommended that unit managers archive retired versions for future reference if needed.
Electronic copies of all archived and active PBO policies are also readily available on this FPG website.
Policies reflect the "rules" governing the implementation of PBO processes. Procedures on the other hand, represent an implementation of the policy and should evolve over time as new tools emerge, new processes are designed, new compliance requirements are mandated where modifications are required. As a consequence, rather than combine "policies" in a single document, PBO policies committee separates them as two separate documents.
All PBO policies are developed in a standard format. The following sections are found:
Header (see example):
Policy "Effective" date is added upon approval by the policy approval committee (see Policy Approval in this document).
Purpose: Outlines the purpose and rationale of the policy within the frameworks of the key policy drivers as indicated in the "Policy Development" paragraph above.
Overview: The objective of the procedures and a background statement regarding the policy.
Areas of responsibility: Provides a list of departments, units and staff and outlines their functional responsibilities in operationalizing the policy.
Procedure: Step-by-step procedures.
Policy Statement: Represents a statement of FPG's philosophy on the given subject.
Policy Cross Reference: Lists other pertinent PBO policies which may be applicable.
Applicability: Lists all FPG entities to whom the policy may apply.
Monitoring/Accountability: A statement regarding expectations of adherence to active polices and monitoring systems.
Definitions: A concise or detailed definition for certain terms and abbreviations underlined throughout the policy and procedure documents may be found in the "Definitions" section of the manual.
Cognizant Office: Indicates the name and the e-mail address of the owner of the PBO policies and procedures (Director of PBO).
Policy Authority: Indicates the office final approval authority.
Revision History: This section documents the dates of final approvals of all revisions to the policies and procedures. The last date appearing in this section indicates the date of the approval of the most recent revision to the policy and/or procedure.
References: All reference materials and literature used in developing the policies and procedures are listed in this section.
Final policy drafts are submitted to the FPG Budget and Finance committee and BOD for review and approval. Procedures are approved by the PBO Director.
Approved policies are disseminated to all PBO unit managers. Managers are then responsible for implementation of policies within their units. All PBO employees must be trained and sign an acknowledgement of receipt of new policy, training and full understanding thereof.
Implementation timeline may vary anywhere between 120-180 days from the approval date depending on operational and technical complexities, availability of resources and other internal and external factors.
It is recommended that a PBO human resources representative be informed of any significant changes in functional responsibilities of PBO employees triggered by newly implemented policies.
All initial policies are reviewed and approved by FPG Budget and Finance committee and BOD.
Revisions and amendments to existing policies are first reviewed by PBO policies committee before routing for final approval.
A revision date is issued and documented on each policy (see "Written Format" paragraph above for more details).
All approved PBO policies must be reexamined at least once a year ("scheduled"), with the exception of those which have been revised within that time frame.
In special circumstances an "extraordinary" review process may be necessary for immediate amendation and/or revision of any prior approved policy.
PBO policy committee delegates above "scheduled" and "extraordinary" review functions to FPG Quality Development unit, which is responsible for thorough review of the policy, documentation of review and findings, feedback and possible revision recommendations to the PBO policy committee.
It is the responsibility of each PBO operational unit to conduct frequent, regularly scheduled quality reviews to ensure adherence with approved policies. Immediate corrective actions must be taken as necessary. These may include:
UCLA Faculty Practice Group is the authority which oversees and maintains development, approval and implementation of all PBO policies and procedures.
For interpretations of the PBO policies and procedures, resolution of problems and special situations contact:
Anton Loman, Director of Physician Billing Office (firstname.lastname@example.org)