decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 14030 / 14030.1_BASIS_FOR_EXCLUSION_UNDER_1128(B)(6).
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Article Overview
This article summarizes a Medicare manual provision describing the basis for exclusion determinations under Social Security Act section 1128(b)(6). It is relevant to compliance, program integrity, and health care providers, suppliers, and billing professionals who need a high-level understanding of the types of conduct addressed in exclusion policy.
Why This Topic Matters
Understanding the scope of exclusion authority helps providers, suppliers, and compliance teams recognize the kind of payment and service-related issues that can trigger program integrity action. It is also useful for reviewers who track Medicare manual guidance and exclusion-related policy references.
What You Will Learn
- The general statutory basis for exclusion determinations under section 1128(b)(6).
- The broad categories of provider conduct referenced in the Medicare manual provision.
- How the manual frames the term used to describe furnishing items or services for exclusion purposes.
- The types of stakeholders affected by exclusion-related policy guidance.
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Health care providers
- Revenue cycle professionals
- Program integrity staff
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