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ARE YOU READY? For HAC’s – October 1, 2008. Kathy Whitmire September 2008. Where did HAC’s Come From?. Section 5001(c) of the DRA required the Secretary to identify, by October 1, 2007, at least two conditions that: (a) Are high cost or high volume or both,

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Presentation Transcript
where did hac s come from
Where did HAC’s Come From?

Section 5001(c) of the DRA required the Secretary to identify, by October 1, 2007, at least two conditions that:

(a) Are high cost or high volume or both,

(b) Result in the assignment of a case to a

DRG that has a higher payment when

present as a secondary diagnosis, and

(c) Could reasonably have been prevented

through the application of evidence-based guidelines.

what is a hac
WHAT IS A HAC?

Hospital Acquired Conditions

For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission.

That is, the case would be paid as though the secondary diagnosis were not present.

An example of how the HAC provision may effect an MS-DRG payment, beginning October 1, 2008, is presented below.     

hac example
HAC - Example
  • An example of how the HAC provision may effect an MS-DRG payment, beginning October 1, 2008, is presented below:

Principal Diagnosis

Intracranial hemorrhage or cerebral infarction (stroke) with MCC - MS-DRG 064

Secondary Diagnosis

Stage III pressure ulcer (code 707.23 (MCC))

Present on Admission – Y - PAYMENT = $8,030.28

Same Principal Diagnosis

Intracranial hemorrhage or cerebral infarction (stroke) with MCC - MS-DRG 064

Secondary Diagnosis

Stage III pressure ulcer (code 707.23 (MCC))

Present on Admission – N PAYMENT = $5,347.98

confusion at cms
Confusion at CMS

The 8 original selected conditions go to 11 and then back to 10

WHO KNOWS?

8 hac s 3 more 11
8 HAC’s + 3 More = 11

1. Foreign Object Retained After Surgery

2. Air Embolism

3. Blood Incompatibility

4. Stage III and IV Pressure Ulcers

8 hac s 3 more 111
8 HAC’s + 3 More = 11

5. Falls and Trauma

  • Fractures
  • Dislocations
  • Intracranial Injuries
  • Crushing Injuries
  • Burns
  • Electric Shock
8 hac s 3 more 112
8 HAC’s + 3 More = 11

6. Manifestations of Poor Glycemic Control (NEW)

  • Diabetic Ketoacidosis
  • Nonketotic Hyperosmolar Coma
  • Hypoglycemic Coma
  • Secondary Diabetes with Ketoacidosis
  • Secondary Diabetes with Hyperosmolarity
8 hac s 3 more 113
8 HAC’s + 3 More = 11

7. Catheter-Associated Urinary Tract Infection          (UTI)

8. Vascular Catheter-Associated Infection

8 hac s 3 more 114
8 HAC’s + 3 More = 11

9. Surgical Site Infection Following:

  • Coronary Artery Bypass Graft (CABG) - Mediastinitis

10. Surgical Site Infection Following:

  • Bariatric Surgery (NEW)
    • Laparoscopic Gastric Bypass
    • Gastroenterostomy
    • Laparoscopic Gastric Restrictive Surgery
  • Orthopedic Procedures (NEW)
    • Spine
    • Neck
    • Shoulder
    • Elbow
8 hac s 3 more 115
8 HAC’s + 3 More = 11

11.Deep Vein Thrombosis (DVT) /Pulmonary Embolism (PE) (NEW)

  • Total Knee Replacement
  • Hip Replacement
medicare bottom line
Medicare Bottom Line

Medicare expects to save about $20 million a year from the new reimbursement policy, according to acting CMS Administrator Kerry Weems.

The agency has been working with hospitals over the past year to prepare their coding procedures for the policy changes coming in October.

Weems added that CMS is encouraging state Medicaid programs to adopt similar reimbursement policies.

so where do you start
SO - Where do you start?

FIRST FIVE STEPS TO SUCCESS -

STEP ONE

Make administration & board aware of the new HAC program and the potential loss of income.

STEP TWO

Measure your hospital’s risk

  • Determine current status through analysis of data
  • Validate accuracy of reporting
  • Establish action steps
so where do you start1
SO - Where do you start?

STEP THREE

Implement new Policy & Procedure for identifying conditions POA’s (present on admission conditions) and then reporting HAC’s to PI.

STEP FOUR

Develop Strategies for accurate reporting

  • Educate and empower the healthcare team
  • Establish or expand the clinical documentation improvement role
  • Educate hospital staff and medical staff
so where do you start2
SO - Where do you start?

STEP FIVE

  • Establish a review committee or POA Team of the following: CFO Nursing Business Office Medical Records UR – Case Mgmt

Physician

what next
What Next?

The Team approach is KEY!

Clinical Staff & Physicians must understand the importance of POA Indicators!

Case management and Medical Records need to be experts about POA reporting –

know the poa requirements
Know the POA Requirements

General Reporting Requirements

All claims involving inpatient admissions to general acute care hospitals or other facilities that are subject to a law or regulation mandating collection of present on admission information.

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, observation, or outpatient surgery, are considered as present on admission.

POA indicator is assigned to principal and secondary diagnoses (as defined in Section II of the Official Guidelines for Coding and Reporting) and the external cause of injury codes.

know the poa requirements1
Know the POA Requirements

POA Reporting Definitions

Y = Yes - Present at the time of inpatient admission

N = No - Not present at the time of inpatient admission

U = Unknown - Documentation is insufficient to determine if

condition is present on admission

W = Clinically undetermined - Provider is unable to clinically determine whether condition was present on admission or not

poa policy development
POA Policy Development

SAMPLE POLICY LANGUAGE:

The POA guidelines outlined in this policy are not intended to provide guidance on when a condition should be coded, but rather, how to apply the POA indicator to the final set of diagnosis codes that have been assigned in accordance with Sections I, II, and III of the official coding guidelines (ICD-9-CM Official Guidelines for Coding and Reporting.)

Subsequent to the assignment of the ICD-9-CM codes, the POA indicator should then be assigned to those conditions that have been coded. 

http://www.nahdo.org/documents/POA_Guidelines.pdf

poa education resources
POA Education / Resources

REFER TO THE

ICD-9-CM Official Guidelines for Coding and Reporting

http://www.cdc.gov/nchs/data/icd9/icdguide.pdf

ENSURE THAT STAFF UNDERSTANDS THE USE OF V- CODES

ICD-9-CM provides codes to deal with encounters for circumstances other than a disease or injury. The Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01.0 - V84.8) is provided to deal with occasions when circumstances other than a disease or injury (codes 001-999) are recorded as a diagnosis or problem.

  • V Codes indicate a reason for an encounter
    • They are not procedure codes. A corresponding procedure code must accompany a V code to describe the procedure performed.  
to be prepared on oct 1
To Be Prepared on OCT 1
  • Have Policy & Procedure in place and implemented
  • Educate staff on POA and HAC’s
  • Report to Administration & PI Director on all HAC’s
  • Talk to FI regarding their denial codes & process
  • Become familiar with the appeal process. 
  • Make sure medical staff is involved.  If hospital looses claim the RAC then comes after the Physician.

Get ready now!