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CMS proposes NCDs for surgical never events

Healthcare Auditing Weekly, December 9, 2008

CMS proposed three national coverage determinations (NCD) to establish uniform national policies meant to prevent Medicare from paying for never events.

CMS is focusing on the following never events:

• Wrong surgical or other invasive procedures performed on a patient
• Surgical or other invasive procedures performed on the wrong patient
• Surgical or other invasive procedures performed on the wrong body part

According to a CMS press release, the proposed NCDs for certain types of surgical errors are important steps for Medicare in working to reduce or eliminate their occurrence and associated payments.

In 2002, the National Quality Forum created a list of 27 never events, and added one more in 2006. CMS addressed some of these never events through its hospital-acquired conditions (HACs) provisions in the IPPS final rule for fiscal years 2008 and 2009. As of October 1, 2008, CMS no longer pays at a higher rate for an inpatient hospital stay if the sole reason for the enhanced payment is a HAC acquired during the patient’s stay. It is exploring ways it can adapt this policy to other payment systems.

The proposed NCDs could affect payment to hospitals, physicians, and any other healthcare providers and suppliers involved in erroneous surgeries.

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