decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 14013 / 14013
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Article Overview
This article explains how Medicare contractor activities should be coordinated with outside organizations such as peer review groups, Medicaid fraud control units, and state licensure or professional societies. It is relevant to program integrity, medical review, and provider oversight staff who handle referrals, notifications, and follow-up communications. The section outlines broad coordination responsibilities and related documentation and reporting considerations.
Why This Topic Matters
Understanding these coordination requirements helps ensure that suspected fraud, abuse, unethical conduct, and related provider issues are communicated to the appropriate outside entity through the correct internal channels. It is useful for teams responsible for referrals, case handling, and maintaining consistent program integrity workflows.
Article Sections
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14013. Coordination with Outside Organizations
General guidance on sharing information and coordinating activities with external organizations involved in Medicare oversight and provider review. The section covers broad categories of outside entities and internal coordination expectations.
What You Will Learn
- Which types of outside organizations are discussed in relation to Medicare contractor coordination
- How the section frames information-sharing and referral coordination at a high level
- What kinds of provider oversight and program integrity situations are addressed
- Which internal groups and external entities are expected to communicate in these matters
Who Should Read This
- Medicare contractor staff
- Program integrity personnel
- Medical review staff
- Compliance and fraud investigation teams
- Provider oversight professionals
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