decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 14020 / 14020.4_COMPLAINTS_NOT_IMMEDIATELY_RESOLVED.-
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Article Overview
This brief Medicare Carriers Manual article addresses recordkeeping for unresolved fraud or abuse complaints. It is relevant to compliance, carrier operations, and staff who handle referrals, investigations, and case files, and it focuses on the types of documents that should be retained in the file.
Why This Topic Matters
It helps organizations understand the documentation focus of the manual guidance for unresolved complaint handling and case tracking.
What You Will Learn
- What types of documentation are associated with unresolved fraud or abuse complaint files
- How the manual frames record maintenance for complaint-related cases
- Which broad categories of case materials are kept together in a complaint file
- The administrative context for handling complaints that are not immediately resolved
Who Should Read This
- Medical coders
- Compliance staff
- Carrier/claims operations staff
- Healthcare administrators
- Fraud and abuse investigators
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