In federal health care program compliance, the term exclusion means that an individual or entity is
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Medical Office Assistant · Medical Economics, Billing, and Coding
Exclusion, Sanctions, and Reporting Concerns
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The federal list that identifies individuals and entities excluded from participation in federal health care programs is maintained by the
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The primary purpose of excluding individuals and entities from federal health care programs is to
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Which of the following is an example of a federal health care program from which an individual or entity can be excluded?
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Exclusion from federal health care programs can apply to
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Study tools & related lessonsYou’ll learn to · Related
You’ll learn to
- Describe exclusion and sanction concepts, including the purpose of exclusion lists, who maintains them, and how exclusions are imposed and removed.
- Recognize billing prohibitions that prevent payment for items or services furnished, ordered, or prescribed by excluded individuals or entities, and the practice's duty to screen employees, contractors, and vendors.
- Report compliance concerns through proper channels, including the compliance officer, chain of command, hotlines, and government authorities, while staying within the assistant's scope of practice.
- Apply safety and escalation principles so that potential exclusions, improper billing, and other compliance concerns are flagged promptly, objectively, and confidentially.
Sources & references
- Centers for Medicare & Medicaid Services — CMS.gov
- American Health Information Management Association — AHIMA - Health Information and Coding
- AAPC — Medical Coding and Billing
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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