decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Exclusion / Overview
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Article Overview
This overview explains the basic concept of exclusion from federal health care programs and summarizes the roles of HHS and the OIG. It is relevant to compliance, billing, and reimbursement professionals who need a high-level understanding of exclusion-related federal guidance, sanctions, and payment restrictions.
Why This Topic Matters
Exclusion can affect whether claims or other reimbursement-related payments are allowed under federal health care programs, making it important for compliance and revenue cycle teams to recognize the scope of the topic and the agencies involved.
What You Will Learn
- The general concept of exclusion from federal health care programs
- The difference between mandatory and permissive exclusion at a high level
- The federal agencies and guidance sources associated with exclusion
- The broad reimbursement contexts discussed in relation to exclusion
Who Should Read This
- Medical coders
- Billing professionals
- Compliance officers
- Revenue cycle staff
- Healthcare administrators
Codes Discussed
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