Transcript POA – Present on Admission

POA – Present on Admission
Presented by
Laurie Burckhardt
EDI Manager
Agenda
 Background of POA
 Implementation dates
 How to submit
 CMS instructions
 Open discussions
Background
 Deficit Reduction Act (DRA) - signed February
2006
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Initial notification required the Present on Admission
(POA) indicator to be collected for Medicare patients
beginning Oct 1, 2007. A subsequent announcement
modified the target date to January 1, 2008. [link
required]
Requires CMS to select 2 or more infectious
complications that are high cost/high volume to focus
on.
Requires CMS to begin excluding those infections
when they are identified as not present on admission
from the calculation of the DRG beginning October
1,2008.
CMS Implementation Dates
 10/1/2007 – Hospitals should begin reporting the POA code for
acute care inpatient PPS discharges” on or after 10/1/2007
(except for DDE). Information not used for claims adjudication
 1/1/2008 – Claims submitted with discharge dates on or after
this date with no POA Indicators will continue to process, but the
remittance advice will contain a remark code indicating the need
for POA indicators.
 4/1/2008 – Claims submitted with discharge dates on or after
this date with no POA indicators will be returned to the provider
for correct submission of the POA information.
 10/1/2008 – Effective for acute care inpatient PPS discharges
on or after this date, CMS cannot assign cases with these
conditions to a higher paying DRG unless they were present on
admission.
Other Health Plan Implementation
Dates
 At this time could find no other health plan
that will require POA
 WHAIC website has the following:
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5/17/07 Update: Although CMS will ‘require’
POA as of 10/1/07 WHAIC will not require
POA until 1/1/08. CMS will not edit for POA
until 4/1/08. CMS will send remarks on records
without POA during the first quarter of 2008.
WHAIC will allow POA as of 7/1/07.
Electronic Submission
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4010A1 has no means of submitting POA information,
The POA must be reported in K3 segment in the 2300 loop, data element K301
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Positions 1-3= POA,
Position 4= the POA indicator for the principal dx code.
Position 5 begins the reporting of POA indicators for all other dx codes if
applicable.
A “Z” or an “X” must be reported to indicate the end of reporting of the POA
indicators for the “other” dx codes.
The byte following the “Z” or “X” value represents the POA indicator for a submitted e-code if
applicable. If the segment ends in a “Z” or an “X” value, than the e-code was not submitted.
Values for each byte are:
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Y = Yes
N = No
U = unknown
W = clinically undetermined.
1- Represents a space or blank and means the dx code is exempt from reporting
of POA.
Z- Indicates the end of reporting of POA indicators for the other dx codes.
X- Indicates the end of reporting of POA indicators for the other dx codes when
there are special processing situations.
Electronic claim examples
 Examples:
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K3*POAYNU1Z1~ No exception handling, ecode submitted.
K3*POA1YNU1Z~ No exception handling, no
e-code submitted.
K3*POAYNU1XY~ Exception handling, e-code
submitted.
K3*POA1YNU1X~ Exception handling, no ecode submitted.
UB04 Paper instructions
 Form locator 67 Principal Diagnosis Code
and Present on Admission Indicator
 Present on Admission [POA] Indicator
 The eighth digit of FL67 – Principal Diagnosis
and each of the secondary diagnosis fields FL
67A-Q.
 The eighth digit of FL 72 – External Cause of
Injury [ECI] (3 fields on the form).
UB04 Usage instructions
 The POA Indicator applies to the diagnosis codes for claims
involving inpatient admissions to general acute-care hospitals or
other facilities, as required by law or regulation for public health
reporting.
 The POA Indicator is based not only on the conditions known at
the time of admission, but also include those conditions that
were clearly present, but not diagnosed, until after the
admission took place.
 Present on admission is defined as present at the time the order
for inpatient admission occurs – conditions that develop during
an outpatient encounter, including emergency department, are
considered as present on admission.
 The POA Indicator is applied to the principal diagnosis as well
as all secondary diagnoses that are reported.
UB04 usage instructions cont.
 The five reporting options for all diagnosis reporting are as
follows:
Y
N
U
W
(Unreported/Not Used)
Yes
No
No Information in the Record
Clinically Undetermined
Exempt from POA Reporting
Provider
 Assumptions:
 Assumes that the coders have all the
information necessary to code the claims
appropriately.
 Must void and then replace the claim if they
don’t get it right the first time
 Requirements:
 Will require education of the physicians,
coders don’t want to take it directly out of the
discharge summary – some docs aren’t too
good at this
Provider Challenges
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Physician doesn’t catch something in the ER.
Implementation issues
Time consuming & may hold up billing
What do the values actually mean? How will they be
applied equally across the industry?
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U = unknown
W = clinically undetermined.
Represents a space or blank and means the dx
code is exempt from reporting of POA.
 ICD-9 guidelines are inconsistent in identifying
whether or not a condition was present or not on
admission,
Provided by WEDI Business Issues workgroup’s white paper
Questions to consider
 How did they determine the POA was the
appropriate mechanism for helping to gather the
information they needed? Would it have been easier
to go to a new version of the transactions for this
rather than workarounds within the existing
transactions?
 Why are we doing this for one payer? Is this true
administrative simplification? Using the POA on a
claim for just them? Would we have done this for any
other payer? How can we stop this type of mandate
in the future?
 Was a cost benefit analysis for the additional coding
time needed done? If so, is it available for review? If
not, why?
Provided by WEDI Business Issues workgroup’s white paper
Concerns to be considered
 Does this mean that a hospital will need to test for
every possible infection that could be in the
populations? Will this actually increase the cost of
care as hospitals begin to cover themselves??
 Result in changing process and procedures and
ultimately reimbursement. There is a big question
about who will want the data.
 Systems are NOT in place that can move the data
from the medical record data capture to the billing
system. Currently, free form fields are being used to
move the data. This is a concern.
 Providers are still working on NPI, many have not
looked at these requirements.
Provided by WEDI Business Issues workgroup’s white paper
CMS instructions
 MLN Matters Number: MM5499
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5499.pdf
 POA can begin to be reported as of
10/1/2007 with exception of DDE
 Effective 1/1/2008 a new remark code will
appear on remittance if POA is not given
 Effective 4/1/2008 claims will be returned if
POA is missing
Questions?
[email protected]