The Centers for Medicare & Medicaid Services (CMS) has recently updated the "Reporting" section of the Hospital-Acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting web site to describe the remark code that is being shared with providers who are improperly submitting Present on Admission Indicator data.  A description of the remark code is available below.

Beginning October 1, 2007, all Inpatient Prospective Payment System (IPPS) Hospitals are required to submit Present on Admission (POA) Indicator information for all primary and secondary diagnoses.

CMS will be using a phased implementation for the POA Indicator. All IPPS Hospitals should familiarize themselves with the following POA Indicator timeline:

October 1, 2007 IPPS Hospitals are required, by law, to submit the POA Indicator on all primary and secondary diagnoses.

January 1, 2008 CMS will begin processing POA Indicator data and will provide feedback to IPPS hospitals on reporting errors. During the period of January 1, – March 31, 2008 hospitals will be educated on reporting errors and will NOT be subject to returned claims.

IPPS hospitals who improperly submit the Present on Admission Indicator will be receiving education in the form of remark code N36 3, which  provides the following remark: 

"Alert: in the near future we are implementing new policies/procedures that would affect this determination."

Note:  If you have received this remark code, you have improperly submitted Present on Admission Indicator data.  You should contact your Fiscal Intermediary/Medicare Administrative Contractor for information about correct submission of Present on Admission Indicator data.

April 1, 2008 Claims that are submitted for payment that do not contain proper reporting of the POA Indicator will be RETURNED.

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 the POA Indicator.
• POA 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 POA.
• 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.
• Issues related to inconsistent, missing, conflicting or unclear documentation must still 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 the POA Indicator would not be reported.
• CMS does not require a POA Indicator for the external cause of injury code unless it is being reported as an "other diagnosis."

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Page Last Modified: 01/30/2008 4:30:00 PM
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