Wrong-site Surgery – CMS Clarifies the Rules

Payments that can be billed separately such as anesthesiologists and radiologists can also be denied which was something they felt needed to be clarified if an event occurs and those that come in to rescue, the surgeons if needed are not paid as well. BD

There was much publicity when the Centers for Medicare and Medicaid (CMS) placed wrong-site surgery on the list of “Never Events” for which Medicare would not pay hospitals. In publishing the “Never Events” list, CMS said that the federal government would no longer pay hospitals when the wrong surgical procedure was performed. Few people, including hospitals, argued with the idea that hospitals should not be paid for doing the wrong surgical procedure. By denying payment to hospitals, CMS decided that hospital leadership needed to ensure that proper procedures were followed to prevent these wrong surgeries.

What the public may be surprised to know is that as recently as the first half of 2008 (prior to implementation of the “Never List”), twenty percent of Joint Commission surveyed hospitals were cited for failing to have a proper “time out’, part of the Universal Protocol, the process designed to prevent wrong-site surgery. To properly implement this patient safeguard, all members of the surgical team (surgeons, nurses, anesthesiologists) must stop what they are doing and participate in the “time out”.

“Medicare will also not cover hospitalization and other services related to these non-covered procedures.“ These include:

All services provided in the operating room when an error occurs are considered related and therefore not covered.

· All providers in the operating room when the error occurs, who could bill individually for their services, are not eligible for payment.

· All related services provided during the same hospitalization in which the error occurred are not covered.

Physicians Beware: CMS Ups the Financial Ante on Wrong-site Surgery : Hospital Accreditation