The analysis indicated that hospitalized patients experienced > 3 million fewer HACs over the 5-year span (2011–2015) than if the HAC rate had remained at the 2010 level (representing a 21% decline). CMS entitled the program “Hospital-Acquired Conditions and Present on Admission Indicator Reporting” and it views this initiative as an incentive for hospitals to improve patient care.Īs a back-drop to this initiative, CMS recently published annual HAC rates and estimates of cost savings and deaths averted from 2010 to 2015. In other words, hospitals would no longer receive additional payments for the care required as a result of certain accidents and medical errors that occurred during a hospital stay. The Deficit Reduction Act of 2005 mandated a quality adjustment in Medicare Diagnosis Related Group (DRG) payments for certain hospital-acquired conditions (HAC) when the condition was not present on admission (POA) to the hospital. If you disagree with a MEDICALLY NECESSITY determination, see What If You Disagree With Our Decision? in the Member Guide.OPPC: Other Provider Preventable Conditions.Medical services received prior to and after medical evacuation are subject to all coverage requirements and limitations under this health benefit plan. If these services are not pre-approved and arranged in advance through BCBSNC or BlueCard Worldwide, services will not be covered.Transport services, including proper medical supervision during transport, are only eligible for payment if arrangements are made through BCBSNC by calling 1.800.810.2583 (within the United States) or through BlueCard Worldwide by calling 1.804.673.1177 (international arrangements).Covered land or air transportation includes, but is not limited to, commercial stretcher, medical escort, or air ambulance. Transportation shall be made via the most direct and economical route. To have your plan reviewed, email your policy to the event of an unforeseen injury or illness where emergency evacuation is determined to be MEDICALLY NECESSARY for you to be transported under medical supervision to the nearest HOSPITAL or treatment facility for treatment, or to be returned to your place of residence for treatment, BCBSNC will arrange for and pay for reasonable expenses incurred for the transport up to the benefit maximum. If you are considering purchasing insurance in lieu of Student Blue, please contact our office in advance to ensure the plan is acceptable. International students will need to email their insurance policy to have it reviewed, and the Student Insurance office will advise if the plan is acceptable for a waiver, or if enrollment into Student Blue is required. International students with F or J visas will not have the option to waive from the Student Blue plan online and are eligible for waiver only if they are covered by a plan reviewed and approved by the University based on the criteria above. Plans that meet the requirements are generally plans offered through US employment or purchased through the local state marketplace. Travel and Sickness Plans will not be accepted. GBG Insurance, HDL Global Specialty, ISO, PGH (United), PSI, Student Medicover, and Tata AIG are examples of companies that do not meet the waiver requirements. Plans marketed solely to international students are often not filed and approved in the U.S, or compliant with the ACA, and do not meet the Wake Forest University insurance requirements. and compliant with the Affordable Care Act (ACA). Wake Forest University requires all students to be enrolled in a health plan that is filed and approved in the U.S.
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