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Hospital Acquired Conditions – 2012 OIG Work Plan

Monday, January 23rd, 2012

OIG To Review Accuracy Of Present-On-Admission Indicators – Hospital Acquired Conditions

 In 2008, CMS began requiring hospitals to submit indicators for present-on-admission (“POA”) with each Medicare diagnoses code.  This enables CMS to identify which diagnoses were present when the patient was admitted and which developed during the term of the stay in the hospital.  Hospitals do not receive any additional compensation relative to conditions that develop during the term of the hospital stay.  In fact, hospitals with high rates of hospital-acquired conditions receive reduced Medicare payments under the Affordable Care Act.

 The 2012 work plan includes a new item relating to hospital-acquired conditions.  The OIG will be using certified coders to review claims for accuracy of POA indicators.  It appears that the OIG will be providing this information to CMS to assist CMS in fulfilling its responsibilities to reduce payment to hospitals with high levels of hospital-acquired conditions.  This action item reflects increased focus on the issue of hospital acquired conditions.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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