CMS' Do-Not-Pay List Continues to Grow


Last year we informed you of CMS' selection of eight "hospital acquired conditions" (HACs) for which Medicare would no longer reimburse hospitals the higher costs of treatment, effective October 1, 2008. [See "To Err is Human?But It Won't Get Paid: Denial of Medicare Payment for Hospital acquired Conditions," Payment Matters, 9/27/07] In the proposed FY 2009 IPPS rule, CMS proposed to add an additional ten HACs to this "do not pay" list. However, in the final FY 2009 IPPS rule, published in the August 19, 2008 Federal Register, CMS only finalized the following four HACs:

*certain issues related to poor control of blood sugar levels, such as diabetic ketoacidosis and hypoglycemic comas;

*surgical site infections that develop after certain orthopedic procedures;

*surgical site infections that develop after bariatric surgery for obesity;


*deep vein thrombosis (blood clots in the extremities)/pulmonary embolism (the migration of a blood clot into the lung) following certain orthopedic surgeries such as knee and hip replacements.

This revised list of HACs becomes effective on October 1, 2008, and payment will no longer be made for all twelve HACs.

Please see full newsletter for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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