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The Centers for Medicare & Medicaid Services (CMS) has recently updated the educational resources section of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to include the agenda for the Hospital-Acquired Conditions and Hospital Outpatient Healthcare-Associated Conditions Listening Session on Thursday, December 18, 2008. 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 affect 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. Primary and Secondary DiagnosesService: 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) |
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Principal Diagnosis MS-DRG 066 Intracranial hemorrhage or cerebral infarction (stroke) without CC/MCC | -- | $5,347.98 | Principal Diagnosis Example Secondary Diagnosis - Dislocation of patella-open due to a fall (code 836.4 (CC))
MS-DRG 065 Intracranial hemorrhage or cerebral infarction (stroke) with CC - | Y | $6,177.43 | Principal Diagnosis Example Secondary Diagnosis - Dislocation of patella-open due to a fall (code 836.4 (CC))
MS-DRG 066 Intracranial hemorrhage or cerebral infarction (stroke) without CC/MCC - | N | $5,347.98 | Principal Diagnosis Example Secondary Diagnosis - Stage III pressure ulcer (code 707.23 (MCC))
MS-DRG 064 Intracranial hemorrhage or cerebral infarction (stroke) with MCC - | Y | $8,030.28 | Principal Diagnosis Example Secondary Diagnosis - Stage III pressure ulcer (code 707.23 (MCC))
MS-DRG 066 Intracranial hemorrhage or cerebral infarction (stroke) with MCC - | N | $5,347.98 | *Operating amounts for a hospital whose wage index is equal to the national average. | Downloads |
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Page Last Modified: 01/07/2009 12:38:07 PM
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