Apr 1, 2022 • State & Federal / Medicaid

(Policy G-13001, effective 07/01/22)

 

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.

 

NYE-NU-0389-21 February 2022


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