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CMS and Leapfrog Say Don’t Charge for Never Events

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CMS and Leapfrog Say Don’t Charge for Never Events

By Jock Hoffman, CRICO

Related to: Communication, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Background

The Centers for Medicare and Medicaid Services (CMS), and the consortium of health care purchasers known as The Leapfrog Group, are recommending that health care providers should not bill—and insurers should not pay—for the 28 Never Events defined by the National Quality Forum (NQF). Both organizations have declared that “paying for Never Events is not consistent” with goals linked to quality.

Over the past 10 years, 285 malpractice cases filed against CRICO-insured providers involved one or more of the NQF Never Events—accounting for $103 million in incurred losses. Over the same period, CRICO paid $38 million to close cases that had a never event component.

Our Recommendation

If possible, avoid "adding insult to injury" via billing after an avoidable adverse event. Understand and heed established billing policies, and consult with your risk management representatives, before offering to write-off any charges. If free servicing is an option, it can be effective in mitigating anger and frustration. When reviewing a patient bill following any adverse event, consider the following:

  • Could the event have been prevented?
  • What is the magnitude of the injury and amount of billings involved?
  • Is this a one-time write off, or an open-ended clinical situation?
  • Will the free care resolve the patient's complaint, anger, and frustration?
  • In court, adjustments to a patient's bill are not normally considered an admission of liability.

The NQF’s 28 Never Events cover a broad range of care-related incidents: from wrong-site surgery to the physical assault of providers by patients. Hospitals and larger care networks have long been aware of and responsive to many items on the list, but no organization has eliminated problems related to all 28 categories. Physicians in smaller practice settings may need to concern themselves with only a subset of the 28 Never Events, but might want to collaborate with others to find and implement best practices.

Learn More

All providers should familiarize themselves with 1) the NQF list, 2) their individual vulnerability, and 3) existing organizational policies and initiatives aimed at preventing Never Events…including questions related to billing. Institutional risk management and quality improvement personnel will be a valuable resource.

Additional Resources

Is Free Servicing a Good Idea?


February 1, 2007
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