decisionhealth Newsletters, Part B News - 2009 Issue 6 (June)
Services related to ‘never events’ won’t be paid under new rules
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Article Overview
This article explains recent CMS updates to Medicare National Coverage Determinations involving surgical never events and the related denial of payment for associated services. It is aimed at medical practices, coders, and billing staff who need to understand the scope of the policy, when Medicare will or will not pay, and the fact that CMS was developing new HCPCS modifiers for claim processing. The discussion is framed around Medicare coverage guidance and transmittal-based implementation.
Why This Topic Matters
These policy changes affect whether claims tied to certain surgical errors are payable under Medicare and how practices should view related services during the same operative episode or hospital stay. Understanding the update helps billing teams recognize which claims fall under the policy and stay aligned with CMS processing guidance.
Article Sections
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CMS never events policy update
Overview of the Medicare coverage update and the transmittal-based changes being added to the National Coverage Determinations Manual.
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Services CMS says are not covered
Discussion of categories of services and provider billing situations that are treated as related to the event and denied under the policy.
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When CMS will pay
Summary of the broad situations described as payable under the policy, including services CMS treats separately from the event-related denial.
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Effective date and HCPCS modifiers
Notes on the implementation timing of the manual updates and CMS development of new claim-processing modifiers.
What You Will Learn
- The general scope of CMS's never events coverage update
- How the policy affects payment for services surrounding a never event
- Which types of post-event services are discussed as payable or nonpayable in broad terms
- That CMS was developing HCPCS modifiers for claims processing under this policy
- The effective timing of the manual additions
Who Should Read This
- Medical coders
- Billing staff
- Practice administrators
- Revenue cycle personnel
- Compliance staff
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