Name of Manual - Blue Cross and Blue Shield of Minnesota

Serious Preventable
Medical Errors
Reimbursement / Reconciliation
When the negligence, omission, or error on the part of provider
results in the subscriber incurring additional medical expenses no
payment will be made by Blue Cross for, nor shall provider bill
either Blue Cross or the subscriber for said additional medical
expenses. The National Quality Forum has defined certain events
as serious preventable medical errors, and these are the situations
for which no payment shall be made by Blue Cross or the
subscriber.
A listing of these events can be found at www.qualityforum.org.
This listing will be updated periodically by the National Quality
Forum.
Examples of serious preventable errors include:
Unintended retention of a foreign object in a patient after
surgery.
Patient death or serious disability associated with a medication
error (e.g., errors involving the wrong drug, wrong dose, wrong
patient, wrong time, wrong rate, wrong preparation or wrong
route of administration).
Surgery performed on the wrong body part.
Surgery performed on the wrong patient.
Wrong surgical procedure performed on a patient.
Infant discharged to the wrong person.
The Blue Cross and Blue Shield Association's listing of recognized
serious preventable errors can be found on the Association's
website at www.bcbs.com.
An implementation guide for appropriate identification of serious
preventable errors, including a list of ICD-9 CM codes used to
identify serious preventable errors and/or Hospital Acquired
Conditions on a claim can also be found at www.bcbs.com.
The Blue Cross and Blue Shield Association is an association of
independent Blue Cross and Blue Shield plans.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/02/11) 9-5