September 25, 2009
CMS Issues Information About Never Events
Effective Jan. 15, 2009, the Centers for Medicare and Medicaid
Services (CMS) does not cover surgical or invasive procedures necessary
to treat medical conditions when the practitioner erroneously performs:
- A different procedure altogether;
- The correct procedure but on the wrong body part; or
- The correct procedure but on the wrong patient.
inpatient claims, hospitals are required to submit a no-pay claim when
the erroneous procedure is reported. Two claims should be submitted
when there are covered services/procedures provided during the same
stay as the erroneous surgery but unrelated to the erroneous surgery.
For outpatient and practitioner claims, providers are required to
append the applicable HCPCS modifiers to all lines related to the
CMS has issued additional information about “never event” scenarios.