decisionhealth Newsletters, Coder Pink Sheets - 2009 Issue 3 (March)
Final word: CMS won’t pay for ‘never events’
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Article Overview
This article explains CMS’s final national coverage determinations on payment for certain preventable surgical errors often referred to as “never events.” It summarizes the policy context, the kinds of procedures and situations addressed, and the reaction from the American Medical Association. The piece is useful for coders, compliance staff, revenue cycle teams, and providers who need to understand the broad scope of the CMS coverage action and its Medicare implications.
Why This Topic Matters
The article highlights a Medicare coverage policy change that affects how certain serious surgical errors are handled for payment purposes. It matters to coding and compliance professionals because it concerns national coverage policy, claims processing, and the broader documentation and reimbursement environment.
Article Sections
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CMS final national coverage determinations on preventable surgical errors
Introduces the CMS policy action and the types of preventable surgical errors addressed in the coverage determinations. It also identifies the related national quality and patient-safety context.
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Scope of procedures and CMS rationale
Describes the broad categories of procedures and invasive services discussed in connection with the policy. It also summarizes the general reasons CMS gave for the coverage approach.
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AMA response and implementation timing
Summarizes the American Medical Association’s reaction to the proposed policy and notes timing information for the final action and later claims-processing guidance.
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Official resources
Lists where readers can find the CMS press release and related decision memorandum references for the final determinations.
What You Will Learn
- How CMS framed its final national coverage policy on certain preventable surgical errors.
- What general categories of procedures and events were discussed in the coverage action.
- How the article characterizes the policy’s relationship to patient safety and Medicare payment.
- What the AMA said about CMS’s approach and the need for appeals-related consideration.
- Where to locate the official CMS materials referenced by the article.
Who Should Read This
- Medical coders
- Coding auditors
- Compliance professionals
- Revenue cycle staff
- Physicians and hospital administrators
- Patient safety and quality professionals
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