Deficit Reduction Act
Hospital-Acquired Conditions (Present on Admission Indicator)
On February 8, 2006, the President signed the Deficit Reduction Act (DRA) of 2005. Section
5001(c) of 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 DRG 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 it contains at least two conditions.
The statute is available in the Statute/Regulations/Program Instructions section,
accessible through the navigation menu at left.
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 would be paid as though the secondary diagnosis were not present. An example
of how the HAC provision may affect an MS-DRG payment, beginning October 1, 2008, is
presented below.
CMS also required hospitals to report present on admission information for both primary and
secondary diagnoses when submitting claims for discharges on or after October 1, 2007.
Source:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html
Accessed March 13, 2017
ISE 468 ETM 568 Spring 2017
2017 Update ICD-10 HAC List
Effective October 1, 2015, the ICD-10 Version 33 Hospital Acquired Condition
(HAC) list replaced the ICD-9-CM Version 32 HAC list. The ICD-10 HAC List using
V33 of the ICD-10 MS-DRG Definitions Manual is located in ‘Appendix I’ of the
ICD10_Definitions_Manual_MSDRG_v33.0.TEXT.zip file located at the following
link ICD-9 and ICD-10 MS-DRG Definitions Manual Files v33 (Updated 8/20/2015)
[ZIP, 10MB] under the Downloads on this section of the “FY 2016 Final Rule and
Correction Notice Data Files” web page.
An HTML version of the ICD-10 HAC list is also located in Appendix I Hospital
Acquired Conditions (HACS) List at the following link ICD-10-CM/PCS MS-DRG
v33 Definitions Manual Table of Contents - Full Titles - HTML Version (Updated
8/20/2015) - Opens in a new window under the Related Links section.
The FY 2016 v33 ICD-10 Hospital Acquired Condition (HAC) List is located under
the Downloads section below.
The FY 2017 ICD-10 Hospital Acquired Condition List and Update Summary is
displayed under the Downloads section below.
Source: https://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/HospitalAcqCond/icd10_hacs.html Accessed March 13, 2017
ISE 468 ETM 568 Spring 2017