decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Civil Money Penalties / Offenses / Improperly Filed Claims / Improperly filed claims
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Article Overview
This article explains federal civil money penalty and exclusion-related considerations for improperly filed claims in the health care context. It is aimed at coders, compliance staff, auditors, and legal or reimbursement professionals who need a high-level view of the categories of conduct covered and the factors reviewed when penalties are assessed. The article also covers related regulatory references and the broad types of mitigating and aggravating circumstances discussed by the source.
Why This Topic Matters
Understanding how improperly filed claims are evaluated helps compliance and billing teams recognize the broad enforcement framework and the regulatory factors that may affect penalty assessment.
What You Will Learn
- The general scope of improper claim filing issues addressed by the article
- The broad enforcement framework for civil money penalties and possible exclusion
- The categories of factors considered when penalties are assessed
- The types of regulatory considerations tied to mitigation and aggravation
- How prior conduct and financial condition are discussed in the penalty assessment context
Who Should Read This
- Medical coders
- Compliance officers
- Billing and reimbursement staff
- Health care auditors
- Legal and regulatory professionals
Codes Discussed
Code Ranges Discussed
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