Guide provides questions, but answers are up to you
August 1, 2012 2 minutes read
Guide provides questions, but answers are up to you
These are excerpts from “Considerations in the Disclosure of Serious Clinical Adverse Events (SCAEs),” published recently by the American Health Lawyers Association and available at http://tinyurl.com/6wzvbsg:
• Does the SCAE fall within the definition of “Never Events” promulgated by the Centers for Medicare and Medicaid Services (CMS) and thus is subject to non-reimbursement by Medicare? Additionally, is the SCAE subject to the applicable state billing law or Medicaid program “Never Events” policies or considered to be an “avoidable” hospital complication under a commercial insurer’s payment or billing policies?
• If the SCAE does not fall within the definition of “Never Events,” was a request for reimbursement submitted to the patient’s insurance carrier?
• Has a Root Cause Analysis been initiated? Has the cause of the SCAE been identified and, if so, with what level of certainty?
• Has the SCAE been reported to the provider’s risk manager, legal counsel, and professional liability insurance carrier? If so, has the involved professional liability insurance carrier(s) denied coverage for the SCAE or reserved the right to do so at a later date?
• Is the reporting of the SCAE to one or more regulatory agencies mandated by state law and, if so, under what circumstances? Which regulatory agency(ies) must be notified, and what specific information must be included in the report(s)?
• Does the applicable state law mandate disclosure of the SCAE to the patient and/or the patient’s family and other third parties and, if so, what specific information is required to be disclosed?
• Is the information that may be, or is required to be, disclosed to the patient and/or the patient’s family and other third parties consistent with any mandated report of the SCAE to state regulatory agency(ies)?
• If a meeting is held with the patient and/or the patient’s family, who may the patient and/or patient’s family bring to the meeting — other relatives, significant other, friend, attorney, clergy?
• Will the patient and/or the patient’s family be provided with anything in writing and, if so, who will have input in the preparation of the written response, and has the final draft been reviewed by the risk manager, legal counsel, and professional liability insurance carrier?
• Will the provider allow the meeting to be recorded by the patient, if requested?
• Who will be designated to attend the meeting on behalf of the provider and the involved clinician(s)?
• If the family requests copies of the patient’s medical records, are they authorized to receive them under applicable state and federal confidentiality laws and regulations in the absence of written patient authorization?
• Is the information that may be disclosed to the patient and/or the patient’s family consistent with any mandated report of the SCAE to state regulatory agency(ies)?
These are excerpts from Considerations in the Disclosure of Serious Clinical Adverse Events (SCAEs), published recently by the American Health Lawyers Association and available at http://tinyurl.com/6wzvbsg:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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