Never Events Sample Clauses

Never Events. Adverse events that are serious, largely preventable, and of concern to both the public and health care Providers for the purpose of public accountability as defined by the National Coverage Determinations (NCD) or the Division. The Never Events as defined in the NCD or the Division include ambulatory surgical centers (ASC) and practitioners as listed in the Mississippi State Plan.

Never Events. Each Contracted Provider shall use best efforts to comply with applicable state and federal reporting or other requirements relating to Never Events and/or Serious Adverse Events, as the applicable term is defined by the National Quality Forum or by state or federal law. Contracted Providers shall not bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a Payor, Company or Covered Person for any charges associated with Never Events and/or Serious Adverse Events. To the extent a Contracted Provider receives any payment in connection with a Never Event or Serious Adverse Event, the Contracted Provider shall promptly refund such amount.

Never Events. Adverse events that are serious, largely preventable, and of concern to both the public and health care Providers for the purpose of public accountability as defined by the National Coverage Determinations (NCD). The Never Events as defined in the NCD include ambulatory surgical centers (ASC) and practitioners.

Never Events. In the event a "never event" occurs in connection with Participating Facility rendering services to a Customer, Participating Facility will take the then-current steps recommended by the Leapfrog Group. At present, these steps are set forth in the Leapfrog Group’s "Position Statement on Never Events" (▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇) and are as follows: i) Apologize to the patient and/or family affected by the never event; ii) Report the event to United and to at least one of the following agencies: The Joint Commission, as part of its Sentinel Events policy; state reporting program for medical errors; or a Patient Safety Organization (e.g. Maryland Patient Safety Center); iii) Perform a root cause analysis, consistent with instructions from the chosen reporting agency; and iv) Waive all costs directly related to the event. In order to waive such costs, Participating Facility will not submit a claim for such costs to United or Payer (except as required by an applicable Payment Policy) and will not seek or accept payment for such costs from the Customer or anyone acting on behalf of the Customer. For purposes of this section 1.6, a "never event" is an event included in the list "serious reportable events" published by the National Quality Forum (NQF), as the list may be updated from time to time by the NQF and adopted by Leapfrog.

Never Events. “Never Event” means errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, as further defined by CMS or such other guidance issued by CMS. Notwithstanding any provision in this Agreement to the contrary, when any Never Event occurs with respect to a Covered Person, the Provider shall neither bill, nor seek to collect from, nor accept any payment from TrueCare or Covered Person for such events. If Provider receives any payment from TrueCare or Covered Person for a Never Event, it shall refund such payment to the person or entity making the payment within ten (10) business days of becoming aware of such receipt or TrueCare may offset amounts owed from future payments in accordance with Law. Further, Provider shall cooperate with TrueCare, to the extent reasonable, in any TrueCare initiative designed to help analyze and/or reduce Never Events.

Never Events. E. Commissioning for Quality and Innovation (CQUIN)

Never Events. For each never event defined within the NHS Never Events Policy Framework, the Never Event Consequence (per occurrence) will be the recovery of the cost of the procedure and no charge to the Commissioner/Authority for any corrective procedure or care. This is in line with applicable Guidance.

Never Events a) The Contractor is required to develop claims and payment policies and procedures regarding “never events” or “hospital acquired conditions” that are consistent with the Medicaid program. Specifically this includes: i) Development of the capacity for claims systems to recognize the presence or absence of valid “present on admission” (POA) indicators for each inpatient diagnosis, using codes as described by the Centers for Medicare and Medicaid Services for Medicare, no later than June 30, 2009; ii) Development of the capacity for claims systems to reject/deny claims that do not have valid POA indicators (corrected claims can be resubmitted), with the initiation of this edit no later than June 30, 2009; iii) Development of policies and procedures that will reject or modify any inpatient charges resulting from any “never event” or “hospital acquired condition” (pursuant to the current list of implemented items provided on the Department of Health and HPN websites), no later than June 30, 2009; A) The methodology for claims adjustment shall be consistent with current Medicaid program guidance provided on the Department of Health and HPN websites. B) In the event that payment for inpatient claims is not based on DRGs, the Contractor shall develop a system that is equivalent in result to the methodology developed by Medicaid program. iv) Development of an audit or review capacity to ensure that claims are submitted accurately and adjudicated consistent with this policy. b) The Contractor is required to submit inpatient claims to MEDS with valid POA fields as of June 30, 2009. 12. The attached Appendix C, “New York State Department of Health Requirements for the Provision of Family Planning and Reproductive Health Services.” is substituted for the period beginning October 1,2008. 13. Amend Item 5 of Appendix G, “SDOH Requirements for the Provision of Emergency Care and Services” to read as follows:

Never Events. Any non-reimbursable, serious hospital-acquired condition ("Never Event") outlined by the National Quality Forum (NQF) that occurs while Provider is providing health care services and/or Provider Services to a Member will be handled as follows: 5.10.2.1. Provider must immediately report the event to Oscar and any applicable regulatory or licensing agency; 5.10.2.2. Provider shall not submit a claim for such services to Oscar and shall not seek or accept payment for such costs from the Member; 5.10.2.3. Provider must perform a root cause analysis, consistent with instructions from the applicable regulatory or licensing agency; and 5.10.2.4. Provider must communicate with and apologize to the Member and/or Member’s family affected by the Never Event.