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Provider Manual

Never Event

Last Updated on August 28, 2018

“Never event(s)” means events that should never happen in a hospital. For purposes of this policy, never events are limited to surgery on the wrong body part, surgery on the wrong patient or the wrong surgery performed on a patient.

“IPPS hospital(s)” means, for purposes of this policy, hospitals that Centers for Medicare and Medicaid Services (CMS) defines as inpatient prospective payment systems (IPPS) hospitals and critical access hospitals.

Policy

Security Health Plan will not reimburse for hospital services associated with a never event or permit IPPS hospitals to bill members.

Security Health Plan responsibility

  • Upon receipt of a bill from an IPPS hospital for services related to a never event, Security Health Plan will initiate a quality review. A Security Health Plan medical director will conduct a quality review, after the bill is received, for services related to a never event.
  • Security Health Plan will communicate its reimbursement decision to the IPPS hospital.