It’s important to accurately report Present On Admission (POA) indicators to avoid payment delays, ensure accurate claim payment and compliance with Medi-Cal requirements.
POA indicators refer to a condition that is present at the time inpatient admission occurs. Inpatient hospitals are required to assign a POA indicator to all diagnosis codes submitted on a claim, unless the code is exempt from POA reporting.
What are POA indicators?
POA indicators distinguish between conditions that are present at the time of inpatient admission from those that were developed from complications of care during the hospital stay. Acceptable POA indicators are Y, N, U, W or blank.
Hospitals are required to assign a POA indicator to all diagnosis codes, unless the code is exempt from POA reporting. Check POA exemptions.
What is a Health Care Acquired Condition (HCAC)?
HCACs are conditions or complications that develop during a hospital stay, which were not present at the time the patient was admitted to the hospital. Federal law requires Medicaid programs to demonstrate they are not paying for HCACs as defined by the Centers for Medicare & Medicaid Services (CMS). Common examples of HAC’s include foreign object retained after surgery, air embolism, blood incompatibility, falls and trauma and surgical site infections.
CMS has established 14 categories of HCAC’s, which you can see online.
How to submit POA indicators
POA indicators are entered in boxes 67A through 67Q of the UB-04 claim form. All diagnosis codes must have a POA indicator unless the code is exempt from POA reporting.
Blank indicator fields represent codes exempt from POA reporting.
Incorrect reporting
When POAs aren’t filled out accurately, it can lead to:
- Payment implications for hospital-acquired conditions (HACs).
- Claim denials for noncompliance.
- Audit risk due to unsupported or incorrect coding.
- Delayed reimbursement.
For questions, please call the Claims Customer Service Representative line Monday – Friday, 8:30 a.m. to 4:30 p.m. at 800-700-3874 ext. 5503 and select option 1.
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