Blue Cross Blue Shield of Michigan and Blue Care Network Adopt Policy on Serious Adverse Events

Thursday, July 10, 2008 General News
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New rules result from collaboration with Michigan hospitals, physicians

DETROIT, July 9, 2008 -- With input from physicians and hospitals acrossthe state, Blue Cross Blue Shield of Michigan and Blue Care Network havedeveloped a reimbursement policy on Serious Adverse Events that will go intoeffect on Oct. 1.

The policy is a direct response to reimbursement rule changes by theCenters for Medicare & Medicaid Services. It formalizes what the Blues alreadyhave in place under existing contracts, and continues the Blues' tradition ofcommitment to health care quality and patient safety.

Serious Adverse Events are conditions resulting from medical errors orimproper care that reasonably can be expected to be averted, according to adefinition from Medicare. Under new rules that take effect Oct. 1, Medicareand Medicaid will not pay hospitals for some medical care made necessary byadverse events.

BCBSM and BCN's new policy is consistent with the Blues' existingreimbursement structure under hospital agreements and provider contracts,which do not allow payment for medically unnecessary services, regardless ofcause.

"The Blues received input from our hospital and physician partners duringthe development process to ensure the new policy is clear and addresses allnecessary elements," said Robert Milewski, BCBSM senior vice president forcontracting and hospital relations.

Consistent with Medicare and Medicaid rules, the Blues will not payhospitals for medical care costs necessary due to serious adverse eventsincluding:

The new Blues policy extends to physicians and includes three additionalevents not addressed by Medicare and Medicaid:

As many as nine more events may be added to the Blues' policy after CMSprovides additional guidance in August.

The Blues' new policy was developed in partnership with the MichiganHealth & Hospital Association through the organization's newly establishedPatient Safety Organization.

"The Blues together with Michigan hospitals and health care practitionersare all focused on providing high-quality care as well as care that isefficient, cost-effective and responsive to the patient's needs," saidMilewski. "We have several initiatives underway that support patient safety,such as the MHA Keystone initiative to reduce hospital-acquired infections."

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides andadministers health benefits to 4.7 million members residing in Michigan inaddition to members of Michigan-headquartered groups who reside outside thestate. The company offers a broad variety of plans including: Traditional BlueCross Blue Shield; Blue Preferred, Community Blue and Healthy Blue IncentivesPPOs; Blue Care Network HMO; BCN Healthy Blue Living; Flexible Blue planscompatible with health savings accounts; Medicare Advantage; Part DPrescription Drug plans, and MyBlue products in the under-age-65 individualmarket. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofitcorporations and independent licensees of the Blue Cross and Blue ShieldAssociation. For more company information, visit

Contact: Helen Stojic 313-225-8113Objects left in a body after surgery Air embolism as the result of surgery Blood incompatibility Equipment-associated infections Advanced pressure sores Hospital-acquired injuries, such as falls and burns

SOURCE Blue Cross Blue Shield of Michigan

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