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Hospital Acquired Condition Reduction Amount

CLM_HAC_RDCTN_PYMT_AMT

SECTION 3008 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (ACA) ESTABLISHED THE HOSPITAL-ACQUIRED CONDITION (HAC) REDUCTION PROGRAM . EFFECTIVE BEGINNING FISCAL YEAR (FY) 2015 (DISCHARGES BEGINNING ON OCTOBER 1, 2014), THE HAC REDUCTION PROGRAM REQUIRES THE SECRETARY OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO ADJUST PAYMENTS TO APPLICABLE HOSPITALS THAT RANK IN THE WORST-PERFORMING QUARTILE OF ALL SUBSECTION (D) HOSPITALS WITH RESPECT TO RISK-ADJUSTED HAC QUALITY MEASURES. THESE HOSPITALS WILL HAVE THEIR PAYMENTS REDUCED TO 99 PERCENT OF WHAT WOULD OTHERWISE HAVE BEEN PAID FOR SUCH DISCHARGES.

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath 
ExplanationOfBenefit.adjudication.where(
  category.coding.where(
    system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication'
  ) and
    category.coding.where(
      code = 'CLM_HAC_RDCTN_PYMT_AMT'
    )
).amount.value
Coverage / Claim Type
  • Inpatient
Source View
V2_MDCR_CLM_INSTNL
Source Column
CLM_HAC_RDCTN_PYMT_AMT
Sources
  • FISS
  • NCH
Profiles
  • CMS

Example 

10.01

bluebutton.cms.gov

official website of the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

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