Deficit Reduction Act HospitalAcquired Conditions Present on Admission

Deficit Reduction Act Hospital-Acquired Conditions (Present on Admission Indicator) On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section 5001(c) of DRA requires the Secretary to identify conditions that are: (a) 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. Section 5001(c) provides that CMS can revise the list of conditions from time to time, as long as it contains at least two conditions. The statute is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left. 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 affect an MS-DRG payment, beginning October 1, 2008, is presented below. CMS also required hospitals to report present on admission information for both primary and secondary diagnoses when submitting claims for discharges on or after October 1, 2007. Source: https: //www. cms. gov/Medicare-Fee-for-Service-Payment/Hospital. Acq. Cond/index. html Accessed March 13, 2017 ISE 468 ETM 568 Spring 2017

2017 Update ICD-10 HAC List Effective October 1, 2015, the ICD-10 Version 33 Hospital Acquired Condition (HAC) list replaced the ICD-9 -CM Version 32 HAC list. The ICD-10 HAC List using V 33 of the ICD-10 MS-DRG Definitions Manual is located in ‘Appendix I’ of the ICD 10_Definitions_Manual_MSDRG_v 33. 0. TEXT. zip file located at the following link ICD-9 and ICD-10 MS-DRG Definitions Manual Files v 33 (Updated 8/20/2015) [ZIP, 10 MB] under the Downloads on this section of the “FY 2016 Final Rule and Correction Notice Data Files” web page. An HTML version of the ICD-10 HAC list is also located in Appendix I Hospital Acquired Conditions (HACS) List at the following link ICD-10 -CM/PCS MS-DRG v 33 Definitions Manual Table of Contents - Full Titles - HTML Version (Updated 8/20/2015) - Opens in a new window under the Related Links section. The FY 2016 v 33 ICD-10 Hospital Acquired Condition (HAC) List is located under the Downloads section below. The FY 2017 ICD-10 Hospital Acquired Condition List and Update Summary is displayed under the Downloads section below. Source: https: //www. cms. gov/Medicare-Fee-for-Service. Payment/Hospital. Acq. Cond/icd 10_hacs. html Accessed March 13, 2017 ISE 468 ETM 568 Spring 2017