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Focus on Service:
New CMS Reimbursement Guidelines for Hospital Acquired Infections
 The mission of the Centers for Medicare and Medicaid Services (CMS) is to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries. CMS does this through a continuing effort toward transforming and modernizing America’s healthcare system. One of CMS’s recent changes involved reimbursement for hospital acquired conditions (HAC), based on a provision of the Deficit Reduction Act (DRA) of 2005.
Section 5001(c) of the 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 Diagnostic Related Group 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 at least two of the conditions above are met.
According to the new guidelines, 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 will be paid as though the secondary diagnosis were not present.
Another change from CMS is a requirement that hospitals report present on admission information for both primary and secondary diagnoses when submitting claims for discharges on or after October 1, 2007.
For additional information about these provisions, including a list of HAC condition categories and an MS-DRG payment comparison, please click here.
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