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Medicare and a Never-Event

  • Date Submitted: 05/22/2016 02:36 PM
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Medicare and a Never-Event

Factors that places a patient at risk for pressures ulcers

With new policy set in place by the Centers for Medicare and Medicaid Services (CMS) of no longer providing hospitals and health care organization with reimbursements for hospital acquired conditions such as bed sore or pressure ulcers, leaving the cost with the organization. The policy requires administrators and health care workers to take a closer look at what patients are at risk for developing pressure ulcers.   Several risk factors places a patient at risk for getting pressure ulcers; age, lack of sensory perception, weight loss, poor nutrition and hydration, excess moisture or dryness, bowel incontinence, medical condition affecting blood flow, smoking, limited alertness, muscle spasms (Bedsores, 2014). Based on the risk factors that could cause a patient to have pressure sores, its clear that such risk factors are highly common amongst the elderly or patients that would require the services of a skilled nursing facility. Therefore, it is important for an administrator at this organization receiving patients at from the nursing facility should be aware of accepting patients at risk for bed sores with the new policies set by CMS, with the goal of avoiding any false claims.  

Administrators avoiding false claims

In order for administrator to avoid filing false claims they must first know what procedures are no longer covered by Medicare and Medicaid Services (CMS). These lists of services or claims that are no longer covered by CMS are named “never events”. The idea behind the list of never events is CMS is no longer reimbursing organization for hospital-acquired conditions (Torrey, 2014). Hence, any event that causes the patient harm while in the hospital, would be viewed as a never event, and the cost to relieve the patient of their hospital-acquired condition, as in this case treatment for pressure ulcers. Therefore, understanding the concept of never events...


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