End of Present on Admission (POA) Indicator Logic for Version 5010

Make sure your billing and coding staffs are aware of these changes and properly code the POA Indicator on every claim. Upon implementation of version 5010 of the 837I electronic health care claim, providers will no longer have the ability to report the End of POA indicator.

This change has potential payment implications for Inpatient Prospective Payment System (IPPS) hospitals due to their inability to report this indicator on version 5010. The Grouper software relies on the End of POA indicator to apply the appropriate Hospital Acquired Condition (HAC) logic when determining the Diagnosis Related Group for claims from IPPS hospitals.

CR7280 modifies FISS logic to automatically populate the End of POA indicator with 'Z' for IPPS hospitals using the version 5010 837I health care claim format. This ensures Grouper will apply the appropriate HAC logic, when applicable.

For more information, please refer to MLN Matters Article MM7280:
www.cms.gov/MLNMattersArticles/downloads/MM7280.pdf