MS-DRG countdown: Preparing for POA reporting

Although MS-DRGs take effect Oct. 1, hospitals are not required to report present on admission (POA) indicators until Jan. 1, 2008.

However, hospitals should begin now with their POA preparations. Many hospitals have indicated that they will begin including POA information in their clinical documentation well in advance of Jan. 1. This will allow hospitals to improve their documentation and coding practices before they will impact reimbursement. The following are some tips to assist with your POA preparations:

• Alert physicians that you are going to ask for their cooperation related to POA. Work with physicians on the importance of documentation related to POA and explain why you need this information.
• Apply the POA guidelines to a sample set of records to identify problems with documentation.
• Establish a process for the monitoring of cases coded with a POA indicator of "No."
• Evaluate the coding and documentation requirements for high-risk cases such as decubitus ulcers, hospital acquired injuries, etc.
• It is also a good idea to integrate a POA evaluation into your concurrent review process to provide immediate feedback and to improve documentation.
• Use the ICD-9-CM Guidelines and transmittal 1240 as a tool in your education efforts.
• Pay close attention to gray areas in the guidelines, such as combination codes. The guidelines state that both the chronic and acute conditions must be POA to report it with a "Yes."

After Jan. 1, hospitals will be notified on their Medicare remittance advice if they did not report a valid POA code for each diagnosis on the claim. The financial impact of incorrect POA coding will be felt after April 1, 2008, when Medicare will send back for editing any claims without the proper indicator.

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