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Provider Manual

Never Events

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. 

IPPS hospital responsibility

  • The IPPS hospital will implement a patient safety policy to address never events and provide such policy to Security Health Plan upon request. 
  • The IPPS hospital will bill Security Health Plan for services related to never events. The bill will notify Security Health Plan that a never event has occurred and such notice will initiate Security Health Plan’s procedures, as described above. 
  • The IPPS hospital is encouraged to apologize to the patient and her/his family for the never event, as may be appropriate.