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CMW News: CMS adds two new conditions to do-not-pay list

Case Management Weekly, August 6, 2008

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Only two conditions, instead of the originally proposed nine, will be added to the list of preventable conditions that Medicare will not reimburse hospitals for, CMS announced recently. The changes are part of the final acute care inpatient prospective payment rule (IPPS) and take effect on October 1, 2008.

The new condition categories added for the 2009 fiscal year are blood clots in the leg after knee or hip-replacement surgery and complications resulting from poor control of blood sugar levels. These two conditions were added to the do-not-pay list CMS created last year. That list includes: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters.

The additions to the new list were cut from nine conditions to two based on hospital comments and protests. The rules are put in place to encourage patient safety and to save the program money, officials say.

Sources: Medical News Today, California Healthline, San Francisco Chronicle

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