New reimbursement policy: Diagnosis-related group newborn inpatient stays - Facility

Beginning with dates of services on or after December 1, 2022, Anthem Blue Cross and Blue Shield Medicaid will implement a new facility reimbursement policy titled DRG Newborn Inpatient Stays. The policy indicates that when the reimbursement is based on the diagnosis related group (DRG), newborn inpatient stays should be billed with the appropriate revenue code to match the corresponding DRG code. If there is no Neonatal Intensive Care Unit (NICU) revenue code (0172, 0173, or 0174) listed on the claim, the claim will not group to a sick newborn DRG.

 

For additional information, please review the DRG Newborn Inpatient Stays reimbursement policy at providers.anthem.com/ky.

 

KYBCBS-CAID-000754-22