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Hospital-Acquired Conditions (Present on Admission Indicator)

Overview

The Centers for Medicare & Medicaid Services (CMS) has recently updated all sections of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to describe the changes published in CMS' Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule.

On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section 5001(c) of DRA requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case would be paid as though the secondary diagnosis were not present. An example of how the HAC provision may effect an MS-DRG payment, beginning October 1, 2008, is presented below.

CMS also required hospitals to report present on admission information for both primary and secondary diagnoses when submitting claims for discharges on or after October 1, 2007.

Service:  MS-DRG Assignment

(Examples below are for a single secondary diagnosis only)

Present on Admission (Status of Secondary Diagnosis)

Average Payment* (Based on 50th percentile for FY 2008)

Principal Diagnosis

  • Intracranial hemorrhage or cerebral infarction (stroke) without CC/MCC - MS-DRG 066

--

$5,347.98

Principal Diagnosis

  • Intracranial hemorrhage or cerebral infarction (stroke) with CC - MS-DRG 065

Example Secondary Diagnosis

  • Dislocation of patella-open due to a fall (code 836.4 (CC))

Y

$6,177.43

Principal Diagnosis

  • Intracranial hemorrhage or cerebral infarction (stroke) with CC - MS-DRG 066

Example Secondary Diagnosis

  • Dislocation of patella-open due to a fall (code 836.4 (CC))

N

$5,347.98

Principal Diagnosis

  • Intracranial hemorrhage or cerebral infarction (stroke) with MCC - MS-DRG 064

Example Secondary Diagnosis

  • Stage III pressure ulcer (code 707.23 (MCC))

Y

$8,030.28

Principal Diagnosis

  • Intracranial hemorrhage or cerebral infarction (stroke) with MCC - MS-DRG 066

Example Secondary Diagnosis

  • Stage III pressure ulcer (code 707.23 (MCC))

N

$5,347.98

 

*Operating amounts for a hospital whose wage index is equal to the national average.

 

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Page Last Modified: 09/04/2008 9:24:02 AM
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