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Hospital-acquired Infections Going UnreportedAccording to recent reports, hospital-acquired infections and antibiotic-resistant bacteria or super bugs are a major cause of death among patients in the US. Only medical billing records can show what patients were actually treated for. An article in the Holland Sentinel points out that the problem is that hospital acquired conditions (HACs) are going unreported. The report is based on a 2014 University of Michigan study in which the researchers said that infections acquired both inside and outside hospitals would replace heart disease and cancer as the leading cause of death in hospitals if patients’ medical billing records were examined rather than death certificates.

A HealthGrades survey report found that in 2011, an estimated 722,000 patients caught an infection during a stay in an acute care hospital in the US, causing about 75,000 deaths. In April 2014, the Centers for Disease Control and Prevention (CDC) cited evidence showing that HACs affect one in 25 patients.

The most urgent and serious antibiotic-resistant bacteria that threaten patients in long-term hospitals according to the CDC’s latest report are

  • Carbapenem-resistant Enterobacteriaceae (CRE)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases)
  • Vancomycin-resistant Enterococcus (VRE)
  • Multidrug-resistant Pseudomonas aeruginosa
  • Multidrug-resistant Acinetobacter

According to the report, 1 in 4 catheter- and surgery-related HAIs are caused by these six resistant bacteria.

While data from CDC’s latest annual progress report on HAI prevention show that acute care hospitals have made some progress in preventing most HAIs, there is still scope for improvement. According to the HealthGrades survey report, more than 164,470 in hospital complications could potentially have been avoided if all Medicare recipients from 2008 through 2010 gone to top rated hospitals for treatment. Strictly implementing hand hygiene practices can prevent the spread of bacteria among patients. Doctors and nurses also need to be vigilant about preventing complications related to surgery and/or placement of a catheter.

A new study by University of Michigan researchers published in a JAMA Internal Medicine research letter in March 2016 reported that one in four seniors who are hospitalized will acquire superbugs and carry them along to a nursing home or other post-acute care facility. The most common hospital-acquired infections (HAIs) are:

  • Central line-associated bloodstream infections
  • Catheter-associated urinary tract infections
  • Surgical site infections after surgery
  • Clostridium difficile infections

As far as providers are concerned, the picture is different if medical conditions are present at the time the order for inpatient admission occurs. CMS pays for claims submitted for such cases provided physicians’ documentation and coding support a present on admission (POA) disposition. CMS has a Hospital-Acquired Conditions-Present on Admission (HAC-POA) payment policy. This recent value-based purchasing initiative is aimed at improving the structure of payment incentives to enhance health care delivery. CMS stresses that accurate coding of HACs is essential for these payment incentives to be effective, and also correctly identify whether HAC-associated conditions are present on admission (POA) rather than acquired in the health care setting. Medical coding outsourcing is a practical option to achieve these goals. Established medical coding companies have a team of experts that is knowledgeable about:

  • The hospital-acquired conditions on the CMS list and the relevant ICD-10-CM/PCS codes
  • The effect of HACs and POA on reimbursement
  • Verifying physician documentation to support specific POA indicators and report HAC conditions using ICD-10-CM/PCS codes
  • Applying POA guidelines correctly to assign accurate POA indicators to codes

Point to note: complete and accurate documentation of POAs by physicians is necessary for coders to select the appropriate indicator to use when billing Medicare.