Final Guidance on "Never Events"


CMS recently finalized three national coverage determinations (NCDs) which deny coverage for erroneous surgical procedures. In August of last year, we informed you of CMS's proposed NCDs for certain "never events" related to surgical errors.

Such "never events" are included on the National Quality Forum's list of "serious Reportable Adverse Events." On January 15, 2009, CMS finalized these NCDs, which pertain to:

1. the wrong surgery performed on a patient;

2. surgery performed on the wrong patient; and

3. surgery performed on the wrong body part.

Not only do these policies implement CMS's long standing policy of denying coverage for services that are unreasonable and unnecessary, CMS's acting administrator, Kerry N. Weems believes these policies, "have the potential to reduce causes of serious illness or deaths to beneficiaries…." Ober|Kaler's Emily Wein discusses.

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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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