Under CMS reimbursement rules, which procedure or condition would the hospital not be reimbursed for?

• A. Treatment for a wound acquired at a prior facility
• B. Treatment for a wound acquired at the current facility
• C. Treatment for a chronic wound
• D. Treatment for a new wound

Answer: (A)

The key idea is present-on-admission versus hospital-acquired conditions under CMS payment rules. CMS reimburses for conditions that are present when the patient is admitted (present on admission). If a wound is acquired or develops during the hospital stay at the current facility, it’s considered a hospital-acquired condition and is not reimbursed under the standard payment system. A wound that existed before admission or was acquired at another facility is present on admission and would typically be reimbursed, assuming proper coding indicates POA status. A chronic wound or a wound that is newly identified on admission but not developed during the stay follows the POA guidance similarly, but a wound that actually results from care or occurs during the stay is the one CMS won’t reimburse. Therefore, the wound acquired at the current facility would not be reimbursed.