POA Present on Admission

1
POA Present on Admission

• Presented by
• Laurie Burckhardt
• EDI Manager

2
Agenda

• Background of POA
• Implementation dates
• How to submit
• CMS instructions
• Open discussions

3
Background

• Deficit Reduction Act (DRA) - signed February
  2006
• 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.

4
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.

5
Other Health Plan Implementation Dates

• At this time could find no other health plan that
  will require POA
• WHAIC website has the following
• 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.

6
Electronic Submission

• 4010A1 has no means of submitting POA
  information,
• The POA must be reported in K3 segment in the
  2300 loop, data element K301
• 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
• 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.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

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Electronic claim examples

• Examples
• K3POAYNU1Z1 No exception handling, e-code
  submitted.
• K3POA1YNU1Z No exception handling, no e-code
  submitted.
• K3POAYNU1XY Exception handling, e-code
  submitted.
• K3POA1YNU1X Exception handling, no e-code
  submitted.

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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).

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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.

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UB04 usage instructions cont.

• The five reporting options for all diagnosis
  reporting are as follows
• Y Yes
• N No
• U No Information in the Record
• W Clinically Undetermined
• (Unreported/Not Used) Exempt from POA Reporting

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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
  dont get it right the first time
• Requirements
• Will require education of the physicians, coders
  dont want to take it directly out of the
  discharge summary some docs arent too good at
  this

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Provider Challenges

• Physician doesnt 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?
• 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 workgroups
white paper
13
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 workgroups
white paper
14
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 workgroups
white paper
15
CMS instructions

• MLN Matters Number MM5499
• http//www.cms.hhs.gov/MLNMattersArticles/download
  s/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

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• Questions?
• Laurie.Burckhardt_at_wpsic.com