Medicare_Carriers_Manual / 7560 / 7560

Why This Topic Matters

It helps readers understand how Medicare monitors claim filing obligations and how compliance issues may be documented, educated, and referred when needed. It also clarifies that excluded providers are handled under separate procedures, which is important for accurate compliance administration.

Article Sections

1. Ed. Note: For further information see

   A brief cross-reference to related manual material and claims filing sections.

2. 7560. Monitoring Claims Submission Violations

   General Medicare policy on claim submission responsibilities, compliance monitoring, education efforts, and referral handling.

3. A. General

   Overview of the statutory claim submission requirement, related compliance consequences, and basic program administration context.

4. B. Compliance Monitoring and Provider Education

   Methods for identifying potential violations, reviewing claim data, contacting providers, documenting outreach, and escalating unresolved matters.

5. C. Exception to 7560 A and B When Physician, Other Practitioner, or Supplier Is Excluded From Participating in Medicare Program

   Special handling for excluded parties and the related procedures referenced for claims submitted by or involving excluded providers.