Hospital-Acquired Conditions (HAC) and Never Events

Billing and Reimbursement
Policy Number: RP-I-006

Last Updated: July 7, 2022

  1. Never Events are defined as adverse events or errors in medical care that are clearly identifiable, preventable and serious in their consequences for patients.

    • Performance of wrong procedure (operation) on correct patient 

    • Performance of procedure (operation) on patient not scheduled for surgery  

    • Performance of correct procedure (operation) on wrong side of body parts  

    • Leaving sponge, gauze or surgical instrument in body after surgery    

  2. The terms “HAC” and “Never Events” are not used interchangeably.   

    • HAC is defined by CMS

  3. POA stands for present on admission.    

  4. Acute care inpatient facilities include all acute general hospitals, children’s hospitals, critical access hospitals, long-term acute care hospitals and acute rehabs.

  5. Skilled Nursing Facilitates (SNF) and Veteran’s Administration Medical Centers (VAMC) are exempt from this policy.    

  6. All participating acute care facilities are not permitted to receive or retain reimbursement for inpatient services related to Never Events.    

  7. All participating acute care facilities are required to hold members harmless for any inpatient services related to Never Events.    

  8. Blue Cross and Blue Shield of Nebraska (BCBSNE) follows Medicare’s definition of Never Events/POA/HAC:  

  9. 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.