Modern Healthcare reported, Aetna has “established new, tighter policies” to constitute whether it will pay for “medical care related to errors made by providers.” Under the policies, Aetna has “broken errors into two categories: ‘never events’– three events involving surgery: wrong patient, wrong site and wrong procedure — and 25 serious reportable events as defined by the National Quality Forum. Providers will not be reimbursed for a case involving one of the three never events.” Of the 25 reportable events, “eight will be reviewed by Aetna to determine whether reimbursement should be withheld.” The rest of the events will also be reviewed, “but they will not be considered eligible for adjustments to reimbursement,” an Aetna spokesperson explained. Additionally, Aetna will require providers to also “report the errors to the Joint Commission, a state reporting agency, or a patient-safety organization.”
From the American Association for Justice news release.
