Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
What is Present on Admission Indicator Reporting ?
A Present on Admission (POA) Indicator is used to identify whether a primary or secondary condition was present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery, are considered present on admission.
For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions known as, Hospital Acquired Conditions (HACs), are present at the time of admission. The case will be reimbursed as though the secondary diagnosis were not present. Critical Access Hospitals (CAHs), Long-term Care Hospitals (LTCHs), Cancer Hospitals, Children's Inpatient Facilities, Inpatient Psychiatric Hospitals, Inpatient Rehabilitation Facilities, and Veterans Administration/Department of Defense Hospitals are exempt from this payment provision.
The Florida Blue Present on Admission (POA) Indicator requirement applies to both Inpatient Prospective Payment Systems (IPPS) and Non-IPPS Hospitals. A POA indicator should be submitted with all primary and secondary diagnoses codes, regardless of whether the condition is considered a Hospital Acquired Condition (HAC) or not.
If an indicator of “Y” or “W” is submitted with a HAC condition, the major complicating condition or complicating condition (MCC/CC) is included in DRG grouping logic. HAC conditions submitted with an “N” or a “U” will be excluded from DRG grouping impacts. The “U” indicator is subject to specific guidelines with regard to the patient status code before it is excluded from the DRG grouping
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
Billing J code examples cpt code and description J0702 - Injection, betamethasone acetate 3mg and betamethasone sodium phosphate 3mg ...
PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount OA 4 The procedure code is inconsistent with the modifier used ...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
Drugs & Biologicals: Maximum Allowed Units (MAUs) - Palmetto GBA Medicare cpt code and description J1040 - Injection, methylpredniso...
All Service Codes for Immunization/Vaccine 86615 (CPT) - Antibody; Bordetella 86619 (CPT) - Antibody; Borrelia (relapsing fever) 8...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Procedure Code Description 70370 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique 70...