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CMS decided to select majority of these complication care because they saw them as preventable by adhering to evidence based rules…
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CMS reimbursement rules CMS reimbursement rules CMS reported that the federal payor programs do not reimburse for medical services offered to take care or treat patients of certain complications. CMS decided to select majority of these complication care because they saw them as preventable by adhering to evidence based rules and guidelines. These events have been called the “never events.” The new law implemented by CMS influences the liability risk of people offering inpatient services.
CMS held that when patients enter hospitals to be treated for certain diseases, they do not expect to come out of the hospital with additional injuries, severe conditions or infections that occur during the time of a person’s stay in the hospital. The CMS understood that realizing some of these complications might not be avoidable because many patients suffer from illnesses and injuries that the physician could have prevented if the hospital or the physician could have taken suitable precautions.
As part of reimbursement rules for “never events,” Inpatient facilities have focused to enhance the quality of care patients attains during their course or stay in the hospital. For instance, they have focused on decreasing hospital-acquired conditions such as fractures, severe bedsores and certain infections, and preventable medical mistakes such as conducting surgery on the unintended part of the body that should not take place.
Inpatient facilities have been forced to fully evaluate and assess a patient once admitted in their facility and record the existence of all conditions that may need care, if the condition developed before admission to the hospital, it is not a never event. Further, they have to establish a law that identifies and reacts to conditions that belong to never events. This is how inpatient facilities have changed the way they handle their patients in order to get reimbursements from the CMS.
Reference
Hershey, K.M & Rourke, P.T. (2009). Never event implication: What to do legally when a patient questions the care provided. Retrieved Nov. 19 2012 from
http://www.the-hospitalist.org/details/article/184520/Never-Event_Implications.html Read More
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