CommercialReimbursementMedium impact
Update to Hospital-Acquired Condition Policy Effective November 1, 2025
Florida Blue·FL · General Surgery, Orthopedics·Provider Bulletin
Effective date
Nov 1, 2025
We identified it
Jun 16, 2026
Summary
Florida Blue is expanding its Hospital-Acquired Condition (HAC) payment reduction policy to include commercial inpatient claims from participating acute care hospitals that receive outlier reimbursement based on a percentage of charges. Previously, this policy only applied to MS-DRG inlier claims.
Action Required
Before November 1, 2025: Billing team must ensure all inpatient claims to Florida Blue include Present on Admission (POA) indicators for each diagnosis code. Update billing software to require POA indicators for all Florida Blue commercial inpatient claims. Hospital billing staff should not attempt to collect any HAC-related payment reductions from patients when applied by Florida Blue.