AHA asks CMS to clarify no-pay policies

The American Hospital Association (AHA) sent a letter to CMS asking for further clarification on its no-pay policy for hospital-acquired conditions (HACs) and never events. Specifically, the AHA asked CMS to clarify:

• How are the events defined?
• How will accountability for the event be assigned?
• What costs or services should not be covered?

AHA’s concern is that there are scenarios where it may be difficult to interpret when the CMS no-pay regulations apply. AHA outlined several such scenarios in its letter, such as:

• The removal of a lesion that is on the correct side, but is not the correct lesion, or when there are anatomical abnormalities that lead the clinician to an incorrect site.
• When a potential wrong-site surgery is initiated, but then the procedure is corrected before harm could occur.

The AHA letter asks CMS to address these potential situations, and consider the adoption of an appeals process for hospitals to petition any decisions that they believe were made inappropriately.

Access the AHA letter here.