decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Exclusion / Permissive Exclusion / Permissive exclusion
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Article Overview
This short article explains the general concept of HHS permissive exclusion and how it fits into enforcement for Medicare and Medicaid-related compliance. It is intended for readers who need a high-level understanding of exclusion authority, its administrative purpose, and the broad categories of offenses and rules involved.
Why This Topic Matters
Exclusion is a significant compliance and program integrity issue for organizations and individuals participating in federal health care programs. Understanding the general scope of permissive exclusion helps coding, compliance, and billing professionals recognize when exclusion policy may affect participation and enforcement risk.
What You Will Learn
- The general meaning of permissive exclusion
- How HHS discretion relates to exclusion decisions
- How exclusion functions as an enforcement tool in federal health care programs
- The types of program-related issues broadly associated with permissive exclusion
Who Should Read This
- Medical coders
- Compliance professionals
- Billing staff
- Healthcare administrators
- Revenue cycle professionals
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