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Final NCDs Establish Non-Payment Policy

January 30th, 2009

The Centers for Medicare & Medicaid Services (CMS) issued Jan. 15 final decision memos for three national coverage determinations (NCDs) that establish non-payment policies for certain types of surgical “never events.”

The National Quality Forum (NQF) defines never events as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients.

The three never events, as identified in the NQF’s list of Serious Reportable Events, and their related NCDs are:

Effective immediately, Medicare will no longer reimburse hospitals, physicians or other health care providers for these types of erroneous services or any other related non-covered services. Implementation instructions have not yet been released.

For futher details, read the related Jan. 15 press release on the CMS Web site.

6 Responses to “Final NCDs Establish Non-Payment Policy”

  1. judi Says:
    February 5th, 2009 at 10:21 am

    I’d go along with that.

  2. Vivienne Says:
    February 6th, 2009 at 9:08 am

    Doctors should not be paid for making a mistake.

  3. Rebecca Ackerman Says:
    February 10th, 2009 at 8:13 am

    However, who is going to pay for it? The patient certainly should not be held reponsible for it and they should not have to sue for it, either.

  4. Donna Nelson Says:
    February 11th, 2009 at 12:02 pm

    I don’t think any one should be responsible for paying for that kind of mistake. The hospital, and doctors should not bill anyone, and the patient should automatically be imbursed for that mistake, at agiven set table, such as the one used for worch comp..

  5. Thomas Fitzsimmons Says:
    February 12th, 2009 at 2:56 pm

    I would imagine that this would be just like any other Medicare denial for services “not medically necessary” — that is, the provider of the service MAY NOT bill the patient and must write off the entire cost or be in violation of federal Medicare statutes. Medicare does not allow providers to receive payment from the patient for unnecessary services unless the provider notified the patient in writing prior to the procedure that the procedure would not be covered and that the patient needs to sign the “Advanced Beneficiary Notice” to agree to pay the whole charge out of pocket PRIOR to the service being rendered.
    Obviously, no practitioner could legally notify a patient in advance that they were going to do surgery on the wrong patient, wrong body part, wrong surgery, etc., and so an ABN would not apply. The patient pays nothing to receive surgical “wrongs”. But the provider of service may still be liable to the patient for malpractice damages.

  6. Jasmin Says:
    February 23rd, 2009 at 7:36 am

    The surgeon should be fined for making a “human error”, it falls on the surgeon who schedules the surgery and his practice. How does a surgeon NOT know? Where are the forms the hospital requires that the patient sign before surgery confirming the procedure? This is where the hospital would have to take a loss and write off. This should never happen.. We are not robots and there should be a check point every step of the way from scheduling to when the patient is being prepped for surgery to ensure that these horrific mistakes are never made. The surgeon should be fined and should come before the medical review board. What next… NCD edits for surgeons operating in hospitals where they are not credentialed.

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