- Reason Codes 34929 and 34931: Claims receiving these reason codes are related to the POA indicator.
- Only acute Inpatient Prospective Payment System (IPPS) providers (Type of Bill (TOB) 11X) are required to submit POA indicators on Medicare claims. The following inpatient hospitals are exempt from reporting POA indicators and should not report POAs on their claims:
- Critical Access Hospitals (CAHs)
- Long-Term Care Hospitals (LTHCs)
- Inpatient Rehabilitation Facilities (IRFs)
- Inpatient Psychiatric Facilities (IPFs)
- Cancer hospitals
- Children’s hospitals
- Maryland waiver hospitals
- IPPS hospitals will not report a POA indicator of “1” when billing an exempt diagnosis code on claims submitted via Direct Data Entry (DDE), hard copy or Version 5010. This field must be left blank. TrailBlazer will accept 5010 claims beginning April 1, 2011.
- IPPS hospitals must report a POA indicator of “1” when billing an exempt diagnosis code on claim submitted via Version 4010A1
- IPPS hospitals that submitted claims prior to January 1, 2011, or that had a claim Return to Provider (RTP) via DDE after January 1, 2011, that includes a POA indicator of “1,” and need to correct the claim, must submit a new claim via Electronic Media Claims (EMC) (with a POA of “1”) or via DDE (with a blank POA)
- These changes only affect the billing of exempt ICD-9-CM diagnosis codes. A list of categories and codes exempt from the diagnosis POA requirement is included in CR 7024, 5010 Implementation — Changes to Present on Admission (POA) Indicator “1” and the K3 Segment.
- Only acute Inpatient Prospective Payment System (IPPS) providers (Type of Bill (TOB) 11X) are required to submit POA indicators on Medicare claims. The following inpatient hospitals are exempt from reporting POA indicators and should not report POAs on their claims:
- Reason Code 34929: Contractors have received an emergency update from FISS. This update is currently being tested and claims held in location SM30PA will be released following successful testing.
- Reason Code 34931: CMS has instructed contractors to deactivate reason code 34931. Claims held in location SM30PA will be released for processing. Providers should F9 affected claims in RTP status.
- Reason Code 34919: CMS has instructed contractors to deactivate reason code 34919. Claims held in location SMFPLG will be released for processing. This reason code is related to the POA indicator and was incorrectly editing claims submitted by IPF, IRF and LTCH providers. Providers should F9 affected claims in RTP status.
Thursday, January 20, 2011
More Part A Claims Processing Issues Updates
Following is updated information regarding claims incorrectly editing for the Present on Admission (POA) indicator. These are national issues and CMS has been working diligently with the FISS maintainer to resolve these issues.
