DecisionHealth, DecisionHealth - 2009 Issue 6 (June)

Services related to ‘never events’ won’t be paid under new rules

Your practice needs to know five key takeaways from CMS's "never events" additions to its Medicare National Coverage Determinations (NCD) Manual. Three relate to a recent transmittal ordering your carrier to deny you payment for never events and two are for when CMS will pay. The agency finalized three NCDs for never events - wrong surgery performed on a patient, a surgery performed on the wrong body part and a surgery on the wrong patient - in January (PBN 2/2/09). You are required to submit claims for these instances, but you won't get paid for the service.

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