Present on admission (POA) indicator

All acute care hospitals are required to follow instructions from the Centers for Medicare & Medicaid Services (CMS) regarding the identification of the POA indicator for all diagnosis codes for inpatient claims. Claims submitted without a valid POA indicator will be rejected. Consistent with the CMS requirements for POA indicators, the following facility types are exempt:

 critical access hospitals 

 long-term care hospitals 

 cancer hospitals 

 children’s inpatient facilities 

 inpatient rehabilitation facilities

 psychiatric hospitals 

Member enrollment during an admission 

IBC payment responsibility varies depending on the Member’s coverage, as summarized below: 

 Commercial HMO and PPO Members. IBC is required to cover the admission from the Member’s enrollment date in an IBC plan. If a Member enrolls in a Commercial plan from another Commercial HMO plan, the previous plan should cover the Member’s entire admission. 

 Medicare Advantage HMO and PPO Members. Original Medicare covers the Member through to the discharge date.

If the Member’s benefits plan or regulations conflict with these provisions, actual payments may vary.

Member termination during an admission 

IBC payment responsibility varies depending on Member coverage and provider payment methodology, as summarized below: 

Payment methodology	Line of business
	Commercial HMO and Medicare Advantage HMO/PPO	Commercial PPO
Per diem	Pays to the discharge date	Pays to the last covered day
Per case	Pays the entire case rate	Pays the entire case rate
Percent of charge	Pays to the discharge date	Pays to the last covered day

If the Member’s benefits plan or regulations conflict with these provisions, actual payments may vary

Maternity admissions 

Reimbursement for maternity admissions is inclusive of the mother and newborn days while the mother is inpatient. Neonatal intensive care unit (NICU) and transitional nursery days are paid separately regardless of mother’s status as inpatient. 

 Normal delivery claims. When billing newborn baby charges (e.g., revenue code 0170, 0171, 0172, or 0179) the maternity charges for mother and baby must be combined on the same UB-04 form. NICU charges should also be added to the mother’s inpatient bill using revenue code 0173 or 0174. 

 Detained baby claims. If the baby remains hospitalized after the mother is discharged (i.e., detained baby), a new admission with its own Preapproval is required. The detained baby’s admission date is the same date as the mother’s discharge date. A separate claim for the detained baby’s admission is required. 

 For Members with Federal Employee Program (FEP) coverage. In those cases where the baby requires a higher level of care and is considered sick while the mother is still hospitalized, a separate admission for the baby is needed. The baby’s admission requires its own Preapproval. The baby’s claim is to be billed using either revenue code 0173 or 0174, and the admission date is the same as the Preapproval date.