As part of the Affordable Care Act, Section 2702, California ASCs should be reporting provider-preventable conditions (PPCs) that occur during the treatment of Medi-Cal patients. This is in addition to other adverse event reporting that is required by the Medical Board of California (MBC), Center for Medicare and Medicaid Services (CMS), California Department of Public Health (CDPH) and accreditation bodies.
ASCs are required to report the following PPCs for Medi-Cal patients.
According to the Department of Health Care Services (DHCS) website, providers need to report all PPCs that are associated with claims for Medi-Cal payment or with courses of treatment prescribed to a Medi-Cal patient for which payment would otherwise be available. Providers do not need to report PPCs that existed prior to the initiation of treatment of the beneficiary.
Providers, caring for patients with either Fee-For-Service (FFS) or Managed Care Plan (MCP) Medi-Cal, must report to the Department of Health Care Services the discovery of a PPC after confirmation that the patient is a Medi-Cal beneficiary. Providers are to use the one-page PPC reporting form (DHCS 7107), which includes a description of the PPCs. In addition, MCP network providers must also report the PPC to the beneficiary's plan.
Please note that reporting PPCs for Medi-Cal beneficiaries to DHCS does not remove the reporting requirement of adverse events to the MBC and / or the CDPH, pursuant to Health and Safety Code sections 1279.1 and 1288.55.