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Blues to Stop Paying for ‘Never Events’

November 14, 2007
Blue Cross and Blue Shield plans will no longer pay for serious errors and hospital-acquired conditions called “never events,” a senior executive said at the annual National Business Coalition on Health conference in Scottsdale, Arizona.

“We believe it’s time to not continue to pay for never events,” Kevin Shanklin, executive director of the office of the president at the Blue Cross and Blue Shield Association, told attendees. The 39 Blues plans nationwide insure 100 million people.

Discontinuing these payments could take several years, Shanklin says .

“Part of the work we have to do is build these medical procedure errors into the claims,” he says.

This could include changing coding rules to make never events easier to identify in claims, he added. Never events include performing the wrong surgical procedure, hospital-acquired pressure ulcers and leaving foreign objects in the body after surgery.

No Blues plans were yet denying payments for never events, and some plans will be moving more quickly than others to discontinue payments, Shanklin says. The plans will no longer pay for never events starting October 1, 2008. Other major insurers have said they will adopt similar policies.

This story was filed by by Rebecca Vesely of Modern Health Care, a sister publication of Workforce Management. To comment, please e-mail editors@workforce.com.