CurrentFlorida BluePolicy 18-060

Never Event Wrong Surgery

Governs reimbursement handling for inpatient acute care hospital claims to Florida Blue when a 'Never Event' (wrong surgery, wrong body part, wrong patient) occurs; affects Florida Blue commercial and Medicare Advantage members and all acute care hospitals in Florida.

Policy Summary

PayerFlorida Blue

PolicyNever Event Wrong Surgery

Policy CodePolicy 18-060

Change TypeNo material change

Effective DateMay 17, 2018

Next Review Date

Key ActionClaims containing a Never Event will be denied in their entirety and hospitals should not bill or attempt to collect from the member.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

zeromember financial responsibility for claims with a Never Event

commercial & MAlines of business covered

18-060policy identifier

07/10/2025most recent review

Never Event Coverage Criteria

Never Event coverage criteria

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- Applies to Florida Blue commercial and Medicare Advantage inpatient acute care hospital claims and to all acute care hospitals regardless of participation status.
ALL of the following
- Never Events, as defined in this policy, are not to be billed to Florida Blue; hospitals should not bill or attempt to collect from the member for any claim containing a Never Event.
ALL of the following

Policy Summary

PayerFlorida Blue

PolicyNever Event Wrong Surgery

Policy CodePolicy 18-060

Change TypeNo material change

Effective DateMay 17, 2018

Next Review Date

Key ActionClaims containing a Never Event will be denied in their entirety and hospitals should not bill or attempt to collect from the member.

SourceLink

On This Page

Referenced Codes & CMS Additions

Referenced code systemsmixed

The document references CPT and other medical code sets but does not list specific procedure or diagnosis codes for Never Events.

Incorporation of future CMS Never Events

Policy action for CMS updatesAll future Never Events implemented by CMS will be incorporated into this policy as of the CMS effective date.

Scope of incorporationApplies to any additional Never Event types adopted by CMS after the policy effective date.

Effective date referenceIncorporation occurs as of the CMS effective date for each added Never Event.

Billing and Claim Submission Actions

Billing Rule

Do not bill or collect for claims with a Never Event

Claims that include a Never Event must not be billed to Florida Blue; hospitals should not bill or attempt to collect any amount from the member. Claims containing a Never Event will be denied in their entirety and the member will have zero liability.

Do not submit the claim to Florida Blue for reimbursement when a Never Event is present.
Do not attempt to collect payment from the patient for any portion of a claim containing a Never Event.

Definitions — Never Events

Never Events

DefinitionNever Events: Serious reportable events identified by the National Quality Forum (NQF) that should never occur.

Examples included in policySurgery on the wrong patient; surgery on the wrong body part; wrong surgery on a patient.

Purpose of listIdentified to facilitate reporting, data collection and public accountability for serious, preventable adverse events.

Source of standardizationList originally endorsed by NQF in 2002 as 'Serious Reportable Events' (Never Events).