decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Exclusion / Exclusion FAQs / What is the effect of an exclusion
Subscribe or sign in to view the full article.
Article Overview
This FAQ-style article covers how exclusion from federal health care programs affects billing and payment, which programs are included in the exclusion framework, and the scope of the prohibition as it applies to providers, employers, contractors, and other entities. It is relevant to compliance, revenue integrity, and healthcare administrative staff who need a general understanding of exclusion-related program impact and the existence of a limited exception under federal regulation.
Why This Topic Matters
Exclusion can affect whether services are payable under federal programs and can create downstream compliance risk for organizations that employ, contract with, or work alongside an excluded person. Understanding the broad reach of exclusion helps organizations recognize when payment restrictions and related safeguards may apply.
What You Will Learn
- How exclusion affects payment under federal health care programs
- Which broad categories of federal programs are referenced in the exclusion context
- How the prohibition may extend beyond the excluded person to related entities
- That a limited emergency-services exception is referenced in federal regulation
Who Should Read This
- Healthcare compliance professionals
- Medical billing and coding staff
- Revenue cycle teams
- Healthcare administrators
- Provider enrollment and credentialing staff
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com