AHA, AMA balk at CMS nonpayment proposals for never events

The American Medical Association and the American Hospital Association have come together to challenge CMS proposals that would ban Medicare payments when surgeons operate on the wrong patient, the wrong part of a patient or perform the wrong procedure. While such a rule might sound simple on the surface, the two groups are both arguing that it's not--that CMS will need to do a better job of defining what can be reimbursed and what can't be before it begins withholding funds.

The AMA, for example, argues that the agency shouldn't simply add broad restrictions to its National Coverage Determination process, but should instead, "develop a clear payment policy outlining the circumstances" under which providers would forfeit their payment.

The AHA, for its part, also contended that CMS should determine what costs or services associated with the surgery wouldn't be covered. The hospital group would also like to see CMS provide some help on how it plans to assign responsibility when these errors occur.

To learn more about the study:
- read this Modern Healthcare item

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