History
4/27/09 New policy issued. BCBSNC has developed a set of principles for use by hospitals in determining preventable adverse events for which full or partial nonpayment is appropriate. The hospital should evaluate each occurrence of an adverse event to determine whether these principles apply to that particular occurrence.
6/22/10 Policy Number(s) removed (amw)
10/12/10 The section that was titled “Principles for Nonpayment for Serious Adverse Events was deleted. The section titled, “Serious Reportable Events in Healthcare” was also deleted. Added section titled, “Hospital Acquired Conditions and Codes.” Reviewed by Senior Medical Director 9/2010. Notification given 10/12/2010 for effective date 1/18/2011. (adn)
6/12/12 Added “outpatient” to the statement in the Hospital Acquired Conditions section to read: Participating acute care inpatient hospitals will not be permitted to receive or retain reimbursement for inpatient or outpatient services related to Never Events. Also deleted “inpatient” from the statement that is revised to read: Members will be held harmless for any inpatient services related to Never Events. The following statement was added following the list of the 3 wrong surgeries: Any professional provider associated with a wrong surgery Never Event (surgeon, anesthesiologist, radiologist, etc.) is not eligible for reimbursement. Reimbursement is also not provided for any services in the operating or procedure room where the wrong surgery error occurs. Members will be held harmless for any services related to wrong surgery Never Events. (adn)
1/29/13 Updated list of hospital acquired conditions and codes per CMS IPPS Fiscal Year 2013 Final Rule. New categories added: surgical site infection following cardiac implantable electronic device and iatrogenic pneumothorax with venous catheterization. Pertinent ICD-9 codes were revised in the following categories: blood incompatibility and vascular catheterassociated infection. (adn)
2/11/14 Routine annual policy review. The section titled “Hospital Acquired Conditions and Codes” that contained a table of ICD-9-CM codes was removed from this policy. (adn)
4/15/14 Link to CMS code information added to Billing/Coding section. (adn)
5/13/14 Policy category changed from “Corporate Medical Policy” to “Corporate Reimbursement Policy”. No changes to policy content. (adn)
11/24/15 Routine review. The list of HACs was reformatted for consistency with the list published on the CMS website. The 2013 list is the most current. No additional HACs added for 2014 and 2015. There is no change to policy content or intent. (adn)
12/30/16 Routine review. No change to policy statement. (an)
12/29/17 Routine review. No change to policy statement. (an)
12/14/18 Routine review. There have been no changes in the HAC list by CMS. 2013 list is the most current. No change to policy statement. (an)
12/2/19 Added final paragraph to Description section. Policy statement revised to read: “Participating providers will not be permitted to receive or retain reimbursement for inpatient or outpatient services related to Never Events. Members will be held harmless for any services related to Never Events.” Added “crushing injuries” to list of HACs. Revised coding information for clarity. Claims with no POA indicator populated on an inpatient claim will not be accepted. Link provided for CMS Present on Admission (POA) Exempt List. Notification given 12/2/2019 for effective date 2/11/2020. (an)
2/25/20 Corrected review dates in header. (an)
12/31/20 Routine policy review. Medical Director approved 12/2020. No changes to policy statement. (eel)
4/20/21 Policy format update. No changes to policy statement. (eel)
10/1/21 Clarifying statements added to Reimbursement Guidelines section “All providers, including, but not limited to inpatient psychiatric hospitals, critical access hospitals, or other facilities granted CMS exemption status, are subject to POA, HAC, and Never Event editing.” and “Blue Cross Blue Shield North Carolina (Blue Cross NC) will not reimburse claim lines containing diagnoses or procedures with “N” or “U” POA indicators. The presence of “N” or “U” indicate a condition was hospital acquired and therefore not eligible for reimbursement.“ POA indicators added to Billing and Coding section. Notification given 10/1/2021 for effective date 11/30/2021. (eel)