Payment integrity
Knowledge Center
Centene · payment integrity
Facility and inpatient
Present on admission and hospital-acquired conditions
How the present-on-admission indicator is used, and why a condition acquired in hospital cannot raise the payment for that admission.
Current version
v2.0
in force since 2025-10-01 · as at 2026-04-02
Versions on file
2
back to 2024-02-01
Applies to
Medicare Advantage · Medicaid
All states
Cited in this batch
7
claims tested against it
Where this sits
OwnerFacility Audit Policy
Lines of businessMedicare Advantage · Medicaid
StatesAll states
External basisCMS Hospital-Acquired Conditions and POA Indicator Reporting · 42 CFR 412.4
Version history
v2.0
2025-10-01 → current
In force now
POA validation extended from the CMS hospital-acquired condition list to every reported MCC.
No source document in the index. A finding on this version can
cite it by name but cannot quote a passage.
- A secondary diagnosis reported POA = N or POA = U is not counted towards severity for that admission.
- The admission reprices to the DRG that results when the hospital-acquired condition is excluded.
- The finding is a payment correction, not a quality-of-care determination.
v1.6
2024-02-01 → 2025-09-30
Superseded
POA validation limited to the published hospital-acquired condition list.
No source document in the index. A finding on this version can
cite it by name but cannot quote a passage.
- Conditions on the CMS HAC list reported POA = N do not count towards severity.
Claims in this batch tested against this policy
| Claim | Date of service | Version applied | Role | Paid | At risk |
|---|---|---|---|---|---|
| CLM-0000015 | 09 Mar 2026 | v2.0 | Supporting | $7,532.36 | — |
| CLM-0000016 | 03 Mar 2026 | v2.0 | Supporting | $13,791.64 | — |
| CLM-0000017 | 14 Mar 2026 | v2.0 | Supporting | $5,504.60 | — |
| CLM-0000018 | 07 Mar 2026 | v2.0 | Supporting | $7,012.01 | — |
| CLM-0000019 | 21 Mar 2026 | v2.0 | Supporting | $7,920.05 | — |
| CLM-0000020 | 26 Mar 2026 | v2.0 | Supporting | $5,787.93 | — |
| CLM-0000014 | 05 Mar 2026 | v2.0 | Decisive | $13,888.88 | $6,572.28 |
This policy is synthetic — an internal document written for this demo. The external basis it cites is real.