CMS & Never Events

In July of 2008, the Center for Medicare & Medicaid Services (CMS) issued State Medicaid Director Letter #08-004 to provide guidance related to coordination of State Medicaid payment policies with policies recently adopted by the Medicare program. This is needed when hospital providers bill for selected hospital-acquired conditions (HACs). Prompted by the 2002 & 2006 National Quality Forum list of 28 Never Events as well as the study by the Centers for Disease Control & Prevention that found common medical errors total more than $4.5 billion in additional health care spending a year, the CMS concluded that when acquired in hospital setting, these selected conditions will no longer lead to Medicare payment.
The CMS exercised its authority under section 5001(c) of the DRA by announcing that Medicare will no longer pay the extra cost of treating the following categories of conditions that occur while the patient is in the hospital.

  • Air Embolism
  • Falls and Trauma
  • Pressure Ulcer Stages III and IV
  • Surgical Site infection after
    • Bariatric Surgery Obesity
    • Bypass Surgery (Mediastinitis)
    • Certain Orthopedic Procedures
  • Administration of Incompatible Blood
  • Vascular-Catheter Associated Infection
  • Catheter-Associated Urinary Tract Infection
  • Foreign Object Unintentionally Retained after Surgery

To read the rest of the Director Letter click here

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