Learn What’s Missing in the HAC Reduction Program

Medlearn Media NPOS Non-patient outcome spending

CMS is excluding several measures in the 2023 Hospital Acquired Condition (HAC) section of its Hospital Specific Report (HSR).

The Centers for Medicare & Medicaid Services (CMS) is not including the PSI 90 measure result, measure scores, or total Hospital Acquired Condition (HAC) score for any hospital in its Hospital Specific Report (HSR). CMS is also excluding all Health Associated Infections (HAI) that occurred in 2021 from program calculations for the HAC Reduction Program for the 2024 fiscal year. 

The results are based on the performance period of Jan. 1, 2021 to Dec. 31, 2021. 

CMS notifies hospitals of the exact dates of the scoring calculations review and correction period, and will post these dates on the HAC Reduction Quality Net web page. The posted dates for 2023 are Aug. 15, 2022 to Sept. 13, 2022.

As finalized in the Inpatient Prospective Payment System (IPPS) Final Rule for the 2023 fiscal year, no hospital will receive a payment reduction for the HAC Reduction Program. CMS is still reporting hospitals’ HAI and CMS PSI 90 results on the Care Compare website, for the sake of transparency.

The HAC Reduction Program includes six measures:

  • One claim-based composite measure of patient safety, the Patient Safety and Adverse Events Composite (PSI 90);
  • Five chart-abstracted measures of HAI:
    • Central Line-Associated Bloodstream Infections (CLABSI);
    • Catheter-Associated UTIs (CAUTI);
    • Surgical Site Infections for abdominal hysterectomy and colon procedures;
    • Methicillin-Resistant Staphylococcal Aureus (MRSA) bacteremia; and
    • Clostridium Difficile Infection (CDI).

There are 14 Hospital-Associated Conditions:

  1. Foreign Object Retained After Surgery;
  2. Air Embolism;
  3. Blood Incompatibility;
  4. Stage III and IV Pressure Ulcers;
  5. Falls and Trauma;
  6. Catheter-Associated UTI;
  7. Vascular Catheter Associated Infection;
  8. Surgical Site Infection – Mediastinitis After Coronary Artery Bypass (CABG);
  9. Manifestations of Poor Glycemic Control;
  10. Deep Vein Thrombosis/Pulmonary Thrombosis with Total Knee or Hip Replacements;
  11. Surgical Site Infection – Bariatric Surgery;
  12. Surgical Site Infection – Certain Orthopedic Procedures of Spine, Shoulder, and Elbow;
  13. Surgical Site Infection Following Cardiac Implantable Electronic Device Procedures; and
  14. Iatrogenic Pneumothorax with Venous Catheterization.

The specific ICD-10-CM/PCS codes are listed in the MS-DRG Definitions Manual v40. The HAC Reduction Program website provides a fact sheet as well as a Frequently Asked Questions section.

Programming note: Listen to Laurie Johnson’s live coding report every Tuesday on Talk Ten Tuesdays at 10 a.m. EST.

Facebook
Twitter
LinkedIn

Laurie M. Johnson, MS, RHIA, FAHIMA, AHIMA Approved ICD-10-CM/PCS Trainer

Laurie Johnson is currently a senior healthcare consultant for Revenue Cycle Solutions, based in Pittsburgh, Pa. Laurie is an AHIMA-approved ICD-10-CM/PCS trainer. She has more than 35 years of experience in health information management and specializes in coding and related functions. She has been a featured speaker in over 40 conferences. Laurie is a member of the ICD10monitor editorial board and is a permanent panelist on Talk Ten Tuesdays

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025
Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 19, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 25, 2025

Trending News

Featured Webcasts

Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025
Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025

Trending News

Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more

Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24