decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 14030 / _S_Section_14030
Subscribe or sign in to view the full article.
Article Overview
This article covers the Medicare Carriers Manual discussion of federal exclusion authority, including how it applies across Medicare and other government health programs. It also addresses related program-abuse and quality-assurance enforcement pathways, the roles of DHHS, OIG, OI, and PROs, and the broad consequences of an exclusion action. The section is relevant to compliance staff, auditors, billing personnel, and others who work with provider enrollment, sanctions, and payment integrity.
Why This Topic Matters
Understanding exclusion authority is important for compliance and claims operations because an excluded party can affect payment, billing, and referral-related claims across multiple federal and state programs. The article helps readers recognize the scope of enforcement authority and the agencies involved.
Article Sections
-
14030. Authority to Exclude Practitioners, Providers, and Suppliers of Services
Overview of the statutory authority for excluding health care participants from program payment and the agency delegation framework. The section also addresses related enforcement and sanction pathways referenced in the manual.
What You Will Learn
- The general scope of federal exclusion authority discussed in the manual
- Which organizations and program areas are referenced in the exclusion framework
- How exclusion-related enforcement responsibilities are described at a high level
- The broader payment and compliance implications associated with exclusion actions
Who Should Read This
- Compliance professionals
- Medical billing staff
- Health care administrators
- Auditors
- Provider enrollment teams
- Revenue integrity teams
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com