Policy regulations and hospital reimbursement are at risk with new CMS rules based on Present on Admission criteria
Text of Implications Of Cm Ss Present On Admission (Poa) Provisions Making Dollars And Sense
1. Implications of CMSs Present on Admission Provisions in the ICU: Making Dollars and Sense Todd M. Grivetti, MSN, RN, CCRN, CNML Clinical Nurse Manager Regional Neurosciences Center Poudre Valley Hospital Ft. Collins, CO 2008 Award Recipient
2. Disclosure Statement
Todd M. Grivetti, MSN, RN, CCRN, CNML
Speakers Bureau AACN
Financial Interest - None
3. House Keeping tips
Class Code 169
Session Times 2:15 3:30 pm
Please turn cell phones and pagers off or to Vibrate.
Please utilize the microphones in the room for questions.
4. Learning Objectives
Review, Discuss, and Understand the Present on Admission Provisions
Discuss practical implications of hospital acquired conditions
Incorporate evidence-based research with confidence to establish unit specific guidelines to eliminate hospital-acquired conditions
Develop and implement a customized POA risk assessment.
Other entities monitoring hospital quality and safety initiatives:
Association of Healthcare Research & Quality (AHRQ)
Private Insurance companies
Patient Safety Organizations
8. Evolution to Quality Based Payments
Individual contracts between hospitals and insurers
2004 - CMS/Premier begins demonstration project.
Pay for Performance
Hospital Quality Indicator Demonstration (HQID)
Uses national measures to test payment methods.
Deficit Reduction Act (2005)
Severity adjusted payments
9. Deficit Reduction Act - 2005
CMS selected a variety of hospital-acquired conditions deemed to be reasonably preventable that will receive lower payment if not coded at present on admission.
If a claim includes one of the conditions falling under this policy as a secondary diagnosis without a present on admission indicator, it will be reimbursed as if the secondary diagnosis was not present, leading to reduced payment.
10. Hospital Acquired Conditions selected for Present on Admission Provisions
Pressure Ulcers (decubitus ulcers)
Catheter-associated urinary tract infections
Object left in surgery
Mediastinitis after CABG surgery
Vascular catheter associated infections
11. Hospital Acquired Conditions selected for Present on Admission Provisions
FY-2009 Conditions not selected but being considered.
12. Hospital Acquired Conditions selected for Present on Admission Provisions
Conditions NOT SELECTED for FY-2009 and will not be subjected to provisions
Legionnaires disease Not typically a HAC
Wrong site or Wrong surgery
Medicare WILL NOT pay at all
13. Phased Implementation of POA
FY 08 IPPS Final rule announced: POA provision finalized
Short term, acute care hospitals required to begin reporting POA codes, information not used in claims.
CMS begins processing POA data and provide feedback on POA reporting errors
Hospitals submitting invalid POA code receive remark code on remittance advice; claims with errors still processed.
14. Phased Implementation of POA
April 1, 2008:
Claims that are submitted for payment that do not contain proper POA data will be returned to the provider for correct submission of POA information.
April 15 2008:
FY09 IPPS Proposed Rule announced; CMS outlines plan to expand POA provision to additional conditions
FY09 IPPS Final Rule expected; expansion of condition list in POA provision likely.
POA provision set to officially launch; reimbursement at stake.
15. Practical Implications of POA Financial Clarifying Implications Limitations
16. Practical Implications of POA Indicators
General Reporting Requirements:
POA indicators required for all claims involving Medicare inpatient admissions to acute care hospitals.
POA is defined as present at the time the order for inpatient admission occurs conditions that occur during an outpatient encounter, including emergency department, observation, or outpatient surgery are considered POA.
POA indicators is assigned to both primary and secondary diagnoses.
Issues related to inconsistent, missing, conflicting or unclear documentation must be resolved by the provider.
If a condition would not be coded and reported based on Uniform Hospital Discharge Data Set definitions and current official coding guidelines, then POA indicator would not be reported.
CMS does not require POA indicators for external cause of injury