Beginning Jan. 1, 2008, the Centers for Medicare and Medicaid Services will require the completion of a present-on-admission indicator for every diagnosis on an inpatient acute care hospital claim. Now that CMS has issued instructions, users will be able to begin developing implementation plans and move toward implementation.
Section 5001(c) of the Deficit Reduction Act of 2005 requires hospitals to begin reporting the secondary diagnoses that are present on the admission of patients effective for discharges on or after Oct. 1, 2007. By Oct. 1, 2007, the HHS Secretary must select at least two conditions that are high cost or high volume or both; assigned to a higher-paying DRG when present as a secondary diagnosis; and reasonably preventable through application of evidence-based guidelines. Effective for acute care inpatient PPS discharges on or after Oct. 1, 2008, the Secretary cannot assign cases with these conditions to a higher-paying DRG unless they were present on admission.
This instruction (Transmittal 1240) will require hospitals to begin reporting the POA code on claims with discharges beginning on or after Oct. 1, 2007. Although hospitals must report the POA code on the claim, the information will not be used by claims processing systems until Jan. 1, 2008. Beginning April 1, 2008, if hospitals do not report a valid POA code for each diagnosis on the claim, the claim will be returned to the hospital for correct submission of POA information.
