Rewards / Information Eligible for Rewards

Article Overview

This article covers CMS rules on when information may qualify for a reward in cases involving provider activities and potential sanctions. It is intended for compliance staff, auditors, investigators, and billing professionals who need a high-level understanding of the eligibility criteria and the kinds of reports CMS will not reward. The discussion centers on the level of specificity required, the need to tie information to a particular provider and time period, and situations where a reward is unavailable because the matter is already under review or investigation.