CMS Reimbursement Rules

The Medicare & Medicaid Services (CMS) has provided rules that are meant to improve healthcare delivery by ensuring there is a reduction of hospital-acquired conditions through prescribing rules that stop reimbursement for the “never events” at the health facilities. The preventable conditions that have been listed are 10. These conditions have been referred as “never events” which means that if a patient acquires a preventable condition during his/her stay at the hospital it is not supposed to be added to the payments. Any or combination of these conditions will not be paid by the Medicare. (Cherry & Jacob, 2016).

The ten preventable conditions that have been categorized as Hospital-Acquired Condition (HAC) are; blood incompatibility, foreign objects that may be accidentally retained in the body of the patient after the surgery, stage III & IV pressure, fall & trauma, ulcer development, catheter-related UTI,  Surgical infections and DVT among others. (Cherry & Jacob, 2016).

The above rules impact the nursing care delivery and revenue collection at the health facilities. The health researchers have conducted various studies on how to prevent these events; therefore the facilities have to strictly adhere to the stated rules. Therefore, the CMS reimbursement rules have caused a shift in the patient care delivery care by ensuring that the nurses/physicians improve service delivery since they may face liability for any malpractice that is preventable. The said rules have made patient care delivery to be more reliable, safe and of good quality. To this end, CMS payment rule provides excellent opportunity to use financial incentive to improve health care. (Stone et al., 2010).