Medicare’s Do Not Pay List      

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In an effort to control quality and costs Medicare is now watching for a number of specific mistakes and other preventable conditions that will not be paid for if claims are submitted for them.  This is the latest set of safeguards that Medicare is using to ensure safety and eliminate erroneous claims and payments on those claims. 

A “Do Not Pay” list may sound quite harsh, however, items on the list are not just lightweight mistakes.  These items are serious, such as giving a blood transfusions using the wrong type of blood.  Basically Medicare will not pay for transfusions gone wrong due to human error, and they will not pay for other services that are botched or that should not have been rendered to begin with.

The bottom line is that Medicare will not pay for complications that are preventable.  Some of these complications that will not be paid are extra care costs for breaking up blood clots that are created as a result of knee or hip replacement surgery.  Poor control of blood sugar levels will not be paid for. 

Some individual insurance companies have begun using these strategies as well.  Medicare’s move to keep these situations under control will likely bolster insurance companies in taking steps to do the same.  In addition some of the states are considering having Medicaid adopt a do not pay list, as well.

There are opponents to this line of thinking including the American Medical Association (AMA).  They have stated that there are better ways to contain costs and that they fear that quality of services rendered will actually decrease by enforcing a strict no-pay list because it does not address all circumstances and sometimes situations arise that are not necessarily the hospital’s clear and actual fault.  In addition, it could lead to not attempting to provide treatment or services that could help a patient because of the fear of a complication.

It is clear that the do not pay list will have to be researched and addressed further, but for now it is another tool in trying to keep medical care safe and the costs of the care from skyrocketing further.

Entry Filed under: General-Medicare