Appeals for Denied Claims Submitted by an Ordering and Referring Optout Physician/Non-physician Practitioners Who Are Excluded by the Office of Inspector General (OIG)
This MLN Matters® Special Edition Article is intended for opt-out physicians/non-physician practitioners who elect to order and refer and are excluded by the Office of Inspector General (OIG) and who are listed as an eligible professional on a provider submitted claim to Medicare contractors (Carriers, Fiscal Intermediaries (who maintain an HHA workload, RHHIs, and/or A/B Medicare Administrative Contractors (A/B MACs)) for services provided to Medicare beneficiaries which meet exceptions described at 42 CFR 1001.1901(c).
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Issued by: Centers for Medicare & Medicaid Services (CMS)
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.