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Effective January 1, 2010, UMP will adopt CMS billing policies and reduce AP-DRG payments for the following Hospital Acquired Conditions (as defined by CMS):
- Foreign Object Retained After Surgery
- Air Embolism
- Blood Incompatibility
- Pressure Ulcer Stages III & IV
- Falls and Trauma
- Catheter-Associated Urinary Tract Infection (UTI)
- Vascular Catheter-Associated Infection
- Manifestations of Poor Glycemic Control
- Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG)
- Surgical Site Infection Following Certain Orthopedic Procedures
- Surgical Site Infection Following Bariatric Surgery for Obesity
- Deep Vein Thrombosis and Pulmonary Embolism Following Certain Orthopedic Procedures
For discharges occurring on or after January 1, 2010, hospitals will not receive additional payment if one of the above conditions is acquired during hospitalization (i.e., not present on admission). If the condition develops while the patient is hospitalized, the claim will be paid as if the condition was not present.
This applies only to UMP network hospitals paid on a "per case" basis.
See this table for a detailed list of the diagnoses related to these Hospital Acquired Conditions taken from the Centers for Medicare and Medicaid (CMS) Web site.
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