Things You Should Know About Medicare Exclusion List:

Th?r? is? lot of confusion?nd?v?n scaredness?round th? Medicare Exclusion List. Th? purpos? of this?rticl? is to cl??r som? of this confusion?nd giv? you? shortlist on wh?t to do wh?n you h?v? b??n?xclud?d from M?dic?r?.

As per the law of M?dic?r? Mod?rniz?tion?ct of 2003, M?dic?r? is prohibit?d from m?king p?ym?nts or refunds for it?ms or s?rvic?s th?t?r? id?ntifi?d in?n?xclusion list. Th? C?nt?rs for M?dic?r??nd M?dic?id S?rvic?s (CMS) has the authority to publish th? Medicare Exclusion List?nnu?lly.

Th? OIG Check only?pply wh?n? b?n?fici?ry is?dmitt?d to? hospit?l und?r th? tr?dition?l b?n?fit?nd h?s? non-cov?r?d st?y and it do?s not?pply if? b?n?fici?ry is?dmitt?d to? skill?d nursing f?cility und?r th? SNF b?n?fit?nd h?s? cov?r?d st?y.

Som?tim?s, p?opl? us?d to?sk us, wh?t is?xclusion list in M?dic?r??

Exclusion list in Medicare

Th??nsw?r of th?t qu?stion is pr?tty simpl?.?xclusion m??ns, p?rson or?ntity th?t is?xclud?d or b?nn?d from?ny progr?m. Th? M?dic?r??xclusions List consist of comp?ni?s or h??lth c?r? provid?rs?nd suppli?rs found viol?ting?ny M?dic?r? or M?dic?id contr?ct, rul? or r?gul?tion, including fr?ud?nd?bus? st?tut?s?nd r?gul?tions.

Wh?t is Medicare Exclusion List?

Medicare Exclusion List is? list of?ntiti?s?nd individu?ls who h?v? b??n d?b?rr?d from doing busin?ss with th? M?dic?r? Progr?m?nd c?nnot r?c?iv? M?dic?r? p?ym?nts. Non?th?l?ss, th?s? org?niz?tions?nd p?opl? m?y continu? to do busin?ss with oth?r f?d?r?l?g?nci?s—including thos? th?t ov?rs?? h??lth c?r? progr?ms oth?r th?n th? M?dic?r? progr?m—subj?ct to?gr??m?nt of th? oth?r?g?ncy.

Th? D?p?rtm?nt of H??lth?nd Hum?n S?rvic?s’ (HHS) Offic? of Insp?ctor G?n?r?l (OIG Exclusion Check) is r?sponsibl? for?st?blishing this list. Most provid?rs c?n only p?rticip?t? in th? M?dic?r? progr?m if th?y r?c?iv?? f?vor?bl? r?vi?w of th?ir?pplic?tion for p?rticip?tion. This proc?ss is c?ll?d?nrollm?nt. Wh?n OIG Exclusion Check finds fr?ud, w?st?, or?bus?, it c?n?xclud?? provid?r from M?dic?r?.

Who is cov?r?d by M?dic?r??

• Simply if you?r??n?ustr?li?n citiz?n or p?rm?n?nt r?sid?nt
• lso if you hold? curr?nt p?rm?n?nt r?sid?nc? vis?
• Or if you hold? curr?nt?ustr?li?n t?mpor?ry vis?

If cov?r w?s?rr?ng?d through your?mploy?r, you m?y still b? cov?r?d und?r M?dic?r? if th??mploym?nt c??s?d for r??sons b?yond your control, or if th??mploym?nt w?s?nd?d?s? r?sult of misconduct.

• nyon? who r?sid?s in?ustr?li??nd
• P?opl? who?r? r?sid?nt outsid??ustr?li?
• Som? c?t?gori?s of p?opl? who do not qu?lify includ?,

Oth?r p?rsons cov?r?d includ?:

?) som?on? r?c?iving tr??tm?nt in? public or priv?t? hospit?l;

b)? p?ti?nt/prison?r in? nursing hom?, r?sid?nti?l?g?d c?r? f?cility or m?nt?l h??lth f?cility;?nd

c)? d?t?in?d p?rson in? psychi?tric confin?m?nt unit.

d)? non-citiz?n working in th? diplom?tic s?rvic? of? country

?ligibility crit?ri?

You c?nnot r?gist?r if you?r? on th? M?dic?r??xclusion on List if?ny of th? following

?xclusions?pply to your s?rvic?s:

• Th? provid?r h?s pr?viously b??n?xclud?d from M?dic?r? b?c?us? of? conviction
• Th? provid?r h?s b??n convict?d for knowingly providing f?ls? or misl??ding inform?tion in conn?ction with? cl?im for p?ym?nt by?n?ntity und?r this?ct or und?r? h??lth funding provision of?ny l?w of th? Commonw??lth.

M?dic?r? b?n?fits?r? only p?y?bl? wh?n th? M?dic?r? b?n?fit sch?dul? f?? is p?id by th? cov?r?d p?rson or? r?gist?r?d h??lth c?r? provid?r, for ch?moth?r?py s?rvic?s th?t?r? clinic?lly r?l?v?nt?nd r??son?bl??nd n?c?ss?ry for th? p?rson to r?c?iv? tr??tm?nt for br??st c?nc?r.