Medicare Denies Payment for Wrong Site Surgery

Effective January 15, 2009, Medicare will no longer reimburse surgery providers, including ASCs, when the wrong surgery is performed, surgery is performed on the wrong patient or surgery is performed on the wrong body part. The three situations, also known as "never events," are based on a list of 28 adverse events identified by the National Quality Forum (NQF) as "serious, largely preventable and of concern to both the public and health care providers." The NQF is a national nonprofit organization created to develop and implement a national strategy for health care quality measurement and reporting.

Implementation instructions for processing affected claims will be issued by Medicare later.

Resources:

• Medicare's Press Release on three "never event" national coverage determinations
• Medicare's wrong body part national coverage determination
• Medicare's wrong patient national coverage determination
• Medicare's wrong surgery performed on a patient national coverage determination