TMPPM 2011 >6.4.1.5.3 Inpatient Hospital Claims

6.4.1.5.3 Inpatient Hospital Claims

Medicaid present-on-admission (POA) reporting is required for all inpatient hospital claims that are paid under prospective payment basis methodology with the exception of the following facilities that Medicare exempts or are paid for by TEFRA methodology. These facilities include:

•Critical access hospitals (CAH)

•Cancer hospitals

•Children's inpatient facilities

•State-owned teaching facilities

•RHCs

•Federally qualified health centers (FQHCs)

•Religious nonmedical health-care institutions

•Inpatient psychiatric hospitals and institutes for mental disease (IMD)

•Inpatient rehabilitation facilities (IRF)

•Military hospitals

A POA value must be submitted for each diagnosis on the claim form. Claims submitted without POA are rejected unless the facility is exempt from POA reporting.

POA values are:


POA Value	Description	Payment
Y	Diagnosis was present at the time of admission	Payment will be made by Medicaid when a hospital acquired condition (HAC) is present
N	Diagnosis was not present at the time of admission	No payment will be made by Medicaid when an HAC is present
U	Documentation was insufficient	No payment will be made by Medicaid when an HAC is Present
W	Clinically undetermined.	will be made by Medicaid when an HAC is present
1	Exempt from POA reporting	Exempt from POA reporting

Depending on the POA indicator value, the DRG may be recalculated, which could result in a lower payment to the hospital facility provider. If the number of days on an authorization is higher than the number of days allowed as a result of a POA DRG recalculation, the lesser of the number of days is reimbursed.