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As expected, the Center for Medicare and Medicaid Services has issued a final decision that it will not pay for wrong surgery performed on a patient, surgery performed on the wrong body part, or surgery performed on the wrong patient.
The agency issued the proposal for nonpayment in December. The three surgical errors are considered preventable and are on the National Quality Forum's list of serious reportable events, the CMS said.
“These policies have the potential to reduce causes of serious illness or deaths to beneficiaries and reduce unnecessary costs to Medicare,” CMS Acting Administrator Kerry Weems said in a statement.
Efforts to reduce wrong-site surgeries are widespread. The Joint Commission established a Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery in 2004. An updated version went into effect on Jan. 1.
There are few data on the frequency of surgical never events. The CMS cited a 9-year study that reported an incidence of 1 in 112,994 for wrong-site surgeries not involving the spine (Arch. Surg. 2006;141:353–7). Extrapolating data reported to the Pennsylvania Patient Safety Authority by facilities in that state, Dr. John Clarke, clinical director of the reporting system, estimates that there are four or five wrong-site surgeries each day in the United States. The Pennsylvania data are in the Quarterly Update on the Preventing Wrong-Site Surgery Project, posted on the authority's Web site, www.patientsafetyauthority.org
After the CMS published its proposal, it received comments from 17 individuals and groups. Some said that the agency should establish an appeals process for procedures that are medically necessary but do not exactly match the informed consent. The agency said that the appeals process is the same as for any other noncovered item or service.
The American College of Cardiology, the American Medical Association, the American College of Surgeons, and the American Association of Neurological Surgeons all commented that the CMS needed to clarify how physicians could appeal a noncoverage decision.
These organizations also objected to the CMS using the national coverage decision process to determine payment policy for wrong-site surgery. The ACS wrote that the CMS should develop “a clear payment policy outlining circumstances under which surgery claims would not be payable by Medicare.” Both the ACS and the AANS also urged the agency to remove wrong spine level from the noncoverage determination.
The CMS said that it believes that the national coverage decision process “is appropriate.” The noncoverage decision is effective immediately. Instructions on how to process claims will be issued in the future, the agency said.
As expected, the Center for Medicare and Medicaid Services has issued a final decision that it will not pay for wrong surgery performed on a patient, surgery performed on the wrong body part, or surgery performed on the wrong patient.
The agency issued the proposal for nonpayment in December. The three surgical errors are considered preventable and are on the National Quality Forum's list of serious reportable events, the CMS said.
“These policies have the potential to reduce causes of serious illness or deaths to beneficiaries and reduce unnecessary costs to Medicare,” CMS Acting Administrator Kerry Weems said in a statement.
Efforts to reduce wrong-site surgeries are widespread. The Joint Commission established a Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery in 2004. An updated version went into effect on Jan. 1.
There are few data on the frequency of surgical never events. The CMS cited a 9-year study that reported an incidence of 1 in 112,994 for wrong-site surgeries not involving the spine (Arch. Surg. 2006;141:353–7). Extrapolating data reported to the Pennsylvania Patient Safety Authority by facilities in that state, Dr. John Clarke, clinical director of the reporting system, estimates that there are four or five wrong-site surgeries each day in the United States. The Pennsylvania data are in the Quarterly Update on the Preventing Wrong-Site Surgery Project, posted on the authority's Web site, www.patientsafetyauthority.org
After the CMS published its proposal, it received comments from 17 individuals and groups. Some said that the agency should establish an appeals process for procedures that are medically necessary but do not exactly match the informed consent. The agency said that the appeals process is the same as for any other noncovered item or service.
The American College of Cardiology, the American Medical Association, the American College of Surgeons, and the American Association of Neurological Surgeons all commented that the CMS needed to clarify how physicians could appeal a noncoverage decision.
These organizations also objected to the CMS using the national coverage decision process to determine payment policy for wrong-site surgery. The ACS wrote that the CMS should develop “a clear payment policy outlining circumstances under which surgery claims would not be payable by Medicare.” Both the ACS and the AANS also urged the agency to remove wrong spine level from the noncoverage determination.
The CMS said that it believes that the national coverage decision process “is appropriate.” The noncoverage decision is effective immediately. Instructions on how to process claims will be issued in the future, the agency said.
As expected, the Center for Medicare and Medicaid Services has issued a final decision that it will not pay for wrong surgery performed on a patient, surgery performed on the wrong body part, or surgery performed on the wrong patient.
The agency issued the proposal for nonpayment in December. The three surgical errors are considered preventable and are on the National Quality Forum's list of serious reportable events, the CMS said.
“These policies have the potential to reduce causes of serious illness or deaths to beneficiaries and reduce unnecessary costs to Medicare,” CMS Acting Administrator Kerry Weems said in a statement.
Efforts to reduce wrong-site surgeries are widespread. The Joint Commission established a Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery in 2004. An updated version went into effect on Jan. 1.
There are few data on the frequency of surgical never events. The CMS cited a 9-year study that reported an incidence of 1 in 112,994 for wrong-site surgeries not involving the spine (Arch. Surg. 2006;141:353–7). Extrapolating data reported to the Pennsylvania Patient Safety Authority by facilities in that state, Dr. John Clarke, clinical director of the reporting system, estimates that there are four or five wrong-site surgeries each day in the United States. The Pennsylvania data are in the Quarterly Update on the Preventing Wrong-Site Surgery Project, posted on the authority's Web site, www.patientsafetyauthority.org
After the CMS published its proposal, it received comments from 17 individuals and groups. Some said that the agency should establish an appeals process for procedures that are medically necessary but do not exactly match the informed consent. The agency said that the appeals process is the same as for any other noncovered item or service.
The American College of Cardiology, the American Medical Association, the American College of Surgeons, and the American Association of Neurological Surgeons all commented that the CMS needed to clarify how physicians could appeal a noncoverage decision.
These organizations also objected to the CMS using the national coverage decision process to determine payment policy for wrong-site surgery. The ACS wrote that the CMS should develop “a clear payment policy outlining circumstances under which surgery claims would not be payable by Medicare.” Both the ACS and the AANS also urged the agency to remove wrong spine level from the noncoverage determination.
The CMS said that it believes that the national coverage decision process “is appropriate.” The noncoverage decision is effective immediately. Instructions on how to process claims will be issued in the future, the agency said.