Reimburstment Methology

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Reimbursement Methodologies, HIT 115
Research Project Number 02386600

According to the Centers for Medicare & Medicaid Services (CMS) website, a law became effective as of October 1, 2007, that all acute-care healthcare providers must identify whether a diagnosis was present upon inpatient admission. This concept was summoned due to many concerns about the quality of care within the healthcare system and how the government was overpaying due to hospital errors. After many years of planning the present on admission (POA) indicator was added to the UB form for inpatient Medicare claims. The following six questions provide information about hospital-acquired conditions (HAC) and POA indicators. Question 1: What is a POA indicator? How and when is it used? Present on admission is defined as a condition that is present at the time the order for patient admission occurs. That means that conditions that develop during any outpatient encounter – including in the emergency department, observation, or outpatient surgery, are considered to be POA. POA indicators are increasingly used for multiple purposes, such as, reimbursement, financial planning, clinical research, and quality of care evaluations. In order for the POA indicator to work it is vital for the healthcare provider to provide complete documentation in his/her patient’s medical record to support the determination of whether or not a condition was present on admission. Any issues related to inconsistent, missing, conflicting, or unclear documentation must be resolved by the healthcare provider (“Poa/hac fact sheet”, 2010). Question 2: Why is a POA indicator used?

The purpose of the POA indicator is to differentiate between conditions present at time of admission and conditions that may have developed during an inpatient admission (Welker, 2008).

Question 3: What are the POA indicators? Define each indicator. The CMS has designated the following five indicators that...
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