Medicare “Do Not Pay” List: How Does it Affect You?

If you have never heard of Medicare’s  “Do Not Pay” list, you are not alone.  Most people haven’t heard of it, however it definitely exists.

What the list does is to help Medicare safeguard patients, increase the quality of care by watching for certain specific preventable mistakes and conditions that can be prevented and should not exist.  If Medicare gets billed for these items on the list, they will not pay the provider for them if a claim is submitted.

The list does not contain small mistakes or conditions that can happen.  The items on the list are serious. For example, giving a patient a blood transfusion using the wrong type of blood is no small thing.  This is on the list.  Basically, Medicare will not pay for transfusions that were done incorrectly due to human error, and they will not pay for other services that are the result of mistakes or that should never have been attempted or administered to begin with.

What al of this means is that Medicare will not pay providers for problems or complications that could have been prevented.  Some of items on the “Do Not Pay” list that will not be paid for are extra care costs for breaking up blood clots that are created as a result of knee or hip replacement surgery.  Inadequate control of blood sugar levels will not be paid for.

The good news for patients is that this should make the providers much more careful and judicious when doing their jobs.  They will double-check things that they don’t think twice about now.  This should eliminate mistakes, complications and deaths due to human error and just not taking a little extra time to do the job correctly the first time

As a result of Medicare’s “Do Not Pay” list, many insurance companies, as well as some states are following suit.  They feel this will not only create fewer complications and ensure better quality care.  Let’s hope that is the result.  Only time will tell.

Entry Filed under: Claims