In CMS’ efforts to improve the quality of care, as of October 1, 2008 Medicare will not pay for certain injuries/conditions acquired during inpatient care, these injuries/conditions have been named by CMS as “never events” or “hospital acquired conditions” (HACs). CMS has advised state Medicaid Agencies to amend their statutory language to ensure that payment is not made through Medicaid for those beneficiaries that may have dual eligibility. Read the rest of this entry »
Posts Tagged ‘Denied Claims’
Malpractice- Medicare will not pay for “Hospital Acquired Conditions a.k.a “Never Events”
Wednesday, May 19th, 2010Medicare Denied Claims and Conditional Payments
Thursday, October 29th, 2009Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with. Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):
![DenialsByInsurer2008[2]](http://www.liensettlementsolutions.com/lienresolution/wp-content/uploads/2009/10/DenialsByInsurer20082.jpg "DenialsByInsurer2008[2]")
Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare. 33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers. Some of the common billing errors that providers make are:
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