decisionhealth Newsletters, Answer Books - 2009 Issue 10 (October)
Relatives / Relatives
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Article Overview
This premium article reviews Medicare’s exclusion rules for billing services provided to immediate relatives and household members. It is aimed at physicians, group practices, and billing/coding staff who need a general understanding of when Medicare payment is barred, how the exclusion applies across Part A and Part B settings, and which family or household relationships are included. The article also covers related compliance implications for providers who discover an improper claim and need to correct it.
Why This Topic Matters
Billing errors involving excluded relatives or household members can result in nonpayment and repayment obligations. Understanding the scope of Medicare’s family-member exclusion helps practices avoid improper claims and compliance issues.
What You Will Learn
- The scope of Medicare’s family-member and household-member billing exclusion
- How the exclusion applies across physician services and related incident-to services
- How the rule affects Part A and Part B billing situations
- Which relationship categories are included in the exclusion
- What to consider when an improper claim has already been submitted
Who Should Read This
- Physicians
- Medical billing staff
- Coding professionals
- Practice managers
- Compliance staff
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