decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 2332 / 2332
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Article Overview
This article from the Medicare Carriers Manual addresses an exclusion from Medicare payment involving charges by immediate relatives or members of a beneficiary’s household. It outlines the relationships and household situations covered by the policy and discusses how the exclusion applies to physician, physician-related, and nonphysician supplier services. The article is relevant to Medicare billing and reimbursement professionals, physician practices, suppliers, and compliance staff who need to understand the scope of this long-standing coverage rule.
Why This Topic Matters
Understanding this exclusion helps determine when otherwise billable services fall outside Medicare coverage because of a familial or household relationship. It is especially important for organizations handling physician services, supplier claims, and compliance review under Medicare.
Article Sections
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Ed. Note: For further information see
Editorial cross-references to related manual material and companion topics.
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2332. Charges Imposed by Immediate Relatives of Patient or Members of Household
Overview of the Medicare exclusion and the broad circumstances it addresses.
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A. General
General policy discussion describing the scope of the exclusion and the types of services involved.
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B. Immediate Relative
Definitions and examples of family relationships considered within the policy framework.
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C. Members of Patient's Household
Discussion of who is considered part of the patient’s household for purposes of the exclusion.
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D. Charges for Physician and Physician-Related Services
Application of the policy to physician services and services incident to those services, including incorporation-related context.
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E. Charges for Items Furnished by Nonphysician Suppliers
Application of the policy to nonphysician suppliers and organizational forms referenced in the discussion.
What You Will Learn
- How the Medicare manual frames exclusions involving relatives and household members.
- Which relationship categories are addressed by the policy.
- How the article distinguishes physician-related services from nonphysician supplier charges.
- What organizational structures are discussed in connection with the exclusion.
Who Should Read This
- Medicare billing and reimbursement staff
- Physician practice administrators
- Compliance professionals
- Medical coders and auditors
- Healthcare suppliers
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