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Hospital-Acquired Conditions (HAC) and Never Events
Billing and Reimbursement
Policy Number: RP-I-006
Last Updated: July 7, 2022
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Never Events are defined as adverse events or errors in medical care that are clearly identifiable, preventable and serious in their consequences for patients.
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Performance of wrong procedure (operation) on correct patient
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Performance of procedure (operation) on patient not scheduled for surgery
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Performance of correct procedure (operation) on wrong side of body parts
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Leaving sponge, gauze or surgical instrument in body after surgery
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The terms “HAC” and “Never Events” are not used interchangeably.
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HAC is defined by CMS
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POA stands for present on admission.
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Acute care inpatient facilities include all acute general hospitals, children’s hospitals, critical access hospitals, long-term acute care hospitals and acute rehabs.
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Skilled Nursing Facilitates (SNF) and Veteran’s Administration Medical Centers (VAMC) are exempt from this policy.
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All participating acute care facilities are not permitted to receive or retain reimbursement for inpatient services related to Never Events.
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All participating acute care facilities are required to hold members harmless for any inpatient services related to Never Events.
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Blue Cross and Blue Shield of Nebraska (BCBSNE) follows Medicare’s definition of Never Events/POA/HAC: CMS.gov
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Post-payment audits are generally conducted by BCBSNE of selected medical records. Please refer to Section 14 Provider Audit and Special Investigations Unit (SIU) in the General Policies and Procedures.