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CMS adds conditions to no-pay list

Quality Improvement Monitor, September 19, 2008

Hailed by some as a big step forward for patient safety, CMS’ addition of new conditions to its no-pay list has others fretting and several asking: Are these conditions 100% preventable? The federal agency in July released its final inpatient prospective payment system rule and increased the number of conditions it will no longer pay for unless they were documented as present on admission. The rule takes effect October 1 and adds two new conditions:

  • Certain manifestations of poor control of blood sugar levels
  • Deep vein thrombosis (DVT) or pulmonary embolism (PE) following total knee replacement and hip replacement procedures

    CMS also expanded its surgical site infection measure and will no longer pay for selected surgical site infections following certain elective procedures, including certain orthopedic surgeries, varicose veins, and bariatric surgery for obesity.

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