13 Aug The CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities to decrease the cost associated with never events.

The CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities to decrease the cost associated with never events. CMS has stopped covering the cost associated with never event. Most of these events should not occur as there is evidenced based practice that should be followed in order to prevent these events from occurring. The CMS has a list of never events that they will not remit payment for if they occur because of negligent care to patients. A few examples of these are pressure ulcers, falls, wrong site surgery, objects left in patients after surgery, surgical site Infections, or hospital-acquired infections such as catheter associated urinary tract infections (CAUTI) or central line associated blood stream infections (CLABSI) (CMS, 2008). The reason that CMS has created these reimbursement rules is in part to ensure providers and interdisciplinary care teams are providing care based on the latest evidence-based practice. Patients that are cared for properly in the inpatient setting should not develop pressure ulcers. If they do, however, it is coded as a secondary diagnosis and treatment rendered will not be covered by CMS.

References

Centers for Medicare and Medicaid Services. (2008). CMS Improves patient safety for Medicare and Medicaid by addressing never events. Retrieved from https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-Sheets/2008-Fact-Sheets-Items/2008-08-042.html