All PlansAdministrativeMedium impact
Newsletter Vol. 18, No. 07
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
This policy addresses how DRG (Diagnosis Related Group) assignments are handled for hospital claims when Hospital-Acquired Conditions (HAC) are listed as secondary diagnoses and marked as not Present on Admission (POA). This primarily affects inpatient hospital billing and DRG reimbursement calculations.
Action Required
Immediately: Hospital billing teams should review current DRG assignment protocols for claims with HAC secondary diagnoses. Ensure proper POA indicator documentation is complete before claim submission. Verify billing system correctly processes DRG assignments when HACs are present as secondary diagnoses but not POA.