The Centers for Medicare & Medicaid Services (CMS) has identified a number of diagnoses not present on admission and occur during hospitalization.  These are coded on the hospital claim.  For a complete list of the HACs determined by CMS go to


The report describes in detail the hospital, conditions, category of cases and member information with associated costs.  The header provides the metrics of admits, HAC rates, number of hospitals with HAC cases and potential savings.  The HAC rate is equal to the number of unique HAC claims divided by the number of admissions.


Target Audience for this Report 


Business Processes Impacted by this Report

For health plans with Medicaid and/or Medicare Advantage products the HAC report informs government reports and impacts reimbursement of hospitals.


As a quality indicator the report must be linked to health plan quality reports shared internally and with the network hospitals.  Performance improvement initiatives will incorporate this report to develop strategies for improvement.


Care management/medical management will use the detailed report to monitor members identified to prevent readmissions.


Network development will use the report to determine inclusion/exclusion of hospitals or to create preferred status for hospitals who have low HACs.



Detail and Definitions

This report considers acute care hospitals only, by organization name (from NPI database).  The primary diagnosis is the admitting diagnosis (present on admission).   The client must include the Present On Admission (POA) indicators on the inbound Medical Claims file in order for this report to populate.



  • Admits
  • HAC Rate
  • Members w/HA Conditions
  • Hospitals w/HA Conditions


HAC’s by Hospital

  • Hospital
  • Members
  • Avg Risk
  • Saving Opp


% HAC Cases by Category (Graph)

  • Hospital Acquired Conditions
  • Percentage of Cases with HAC’s



  • Hospital Acquired Conditions
  • Cases
  • Rates/1000



  • Member Number
  • Member Name
  • Provider
  • Admit Date
  • HA Condition
  • Admitting Diagnosis
  • Paid
  • LOS