Thursday, November 10, 2016

Present On Admission (POA) Indicators

Provider Types Affected

** Hospitals who submit claims to fiscal intermediaries (FI) or Medicare Part A/B Administrative Contractors (A/B MACs) for Medicare beneficiary inpatient services.

** Tufts Health Plan recommends that your billing staff is aware of this requirement, and that your physicians and other practitioners and coders are collaborating to ensure complete and accurate documentation, code assignment and reporting of diagnoses and procedures.

Reporting Options and Definitions

N (No) Not present at the time of inpatient admission

U (Unknown) Documentation is insufficient to determine if condition is present at time of inpatient admission

W Not Applicable

Y (Yes) Present at the time of inpatient admission

** The POA data element on your electronic claims has been moved from the K3 segment (version 4010A1) to the HI - PRINCIPAL  DIAGNOSIS and HI - OTHER DIAGNOSIS INFORMATION segments.

NOTE: The value of “1” has been removed in 5010.

Example: Below is an example of acceptable coding on an electronic claim: HI*BF:4821:::::::N*HI*BF:25000:::::::Y

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