The Centers for Medicare & Medicaid Services has announced it will no longer reimburse providers or healthcare facilities for surgical procedures involving the wrong site, wrong surgery or wrong patient.
The new rules took effect Jan. 15 and apply to surgeries and invasive procedures in all healthcare facilities, as opposed to the list of hospital-acquired conditions (such as pressure injuries and infections) that Medicare no longer pays for, which only applies to procedures and hospital stays in inpatient facilities.
"These policies have the potential to reduce causes of serious illness or deaths to beneficiaries and reduce unnecessary costs," said CMS Acting Administrator Kerry Weems, in a statement.
Several medical and industry organizations, including the American Medical Association and the American College of Surgeons, oppose the rules, saying they’re too vague, lack guidance and should have an appeals process. America’s Heath Insurance Plans, a trade organization, strongly supports the national coverage determination.
During the public comment period, the Ambulatory Surgery Center Association said creating a national coverage determination for surgical errors sends the wrong message to the public. ASCA said its members already understand that claims for preventable surgical errors should not be submitted. Creating a specific coverage rule implies "that billing for wrong-site surgery is a major problem and that providers are not sufficiently focused on the issue," according to a CMS memo announcing non-payment for wrong-site surgery.
The American Society of Anesthesiologists has asked CMS for clarification regarding "how it intends to address the scenario in which a separate team of physicians assumes care of the patient after [an error]," according to the memo.
Although the rules began this week, CMS has yet to publish instructions for filing claims associated with preventable surgical errors.
—Kent Steinriede
