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Having a HAC attack? Your guide to hospital-acquired conditions at admission

26 Dec 2016

By: Robben Morin, RN CDS

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“Why on earth are you sending me this query? Why do I need to show if that little stage 1 pressure ulcer was present on admit? Is it an HAC or a POA?”

These are just a few of the questions clinical documentation specialists get from physicians under the Hospital-Acquired Conditions/Present on Admission program. The program began in 2010 under the Affordable Healthcare Act and administered by the Centers for Medicare and Medicaid (CMS).

Why documentation matters

  • CMS may no longer pay hospitals for certain conditions that were not shown to be present at the time of admission or conditions that occurred in the hospital but could have reasonably been prevented.
  • Auditors look for conditions that had been assigned without supporting documentation to validate the diagnosis. In that case, the hospital payment may be reduced or denied.

    How we help you

  • Clinical documentation specialists review charts from admission through discharge to find conditions that are not clearly defined or documented as being present on admission — or if they occurred during the stay.
  • We look for treatments without a diagnosis, ambiguous documentation, conditions with very clear indicators but no diagnosis, or diagnosis with no clinical indicators.
  • We will query the provider if documentation is not clear.


What are the HACs?

  • There are 14 CMS-defined HACs. (MRSA and C-diff will be added in 2017). When these conditions are not identified with a POA status or documented as “undetermined” they are presumed to be HAC. Therefore, a query will be sent to the provider to clarify.
  • Most HACS fall into these categories: Falls and trauma, Iatrogenic Pneumothorax with Venous Catheterization, CLABSI, CAUTI, pressure ulcer stage 3 and 4, manifestations for poor glycemic control, and DVT/PE following orthopedic procedures. The full list is at

Remember… if it wasn’t documented, it wasn’t addressed or it didn’t exist.

Read the full article here for more details and interesting stats about improved outcomes and cost savings since the program began in 2010.