Reimbursement Policy Update: Inpatient Readmissions
Effective July 1, 2022, the Inpatient Readmissions policy will not allow separate reimbursement for claims that have been identified as a readmission to the same or different hospital within the same hospital system.
When a member is readmitted within 14 days as part of a planned readmission and/or placed on a leave of absence, the admissions are considered to be one admission, and only one diagnosis-related group (DRG) will be reimbursed.
Additionally, the following exclusions were added to the policy.
- Readmissions for infants less than 12 months of age at the time of admission
- Readmission for Skilled Nursing (SNF)
- Readmission for Long Term Acute Care (LTAC)
- Sickle Cell Anemia
- Planned readmissions
For additional information, please review the Inpatient Readmission reimbursement policy at https://providerpublic.empireblue.com.
April 2022 Newsletter