Reimbursement policy update: Inpatient Readmissions

Policy G-13001

 

Effective September 1, 2022, the Inpatient Readmissions policy will utilize clinical coding criteria and/or licensed clinical medical review to determine if the subsequent admission is appropriate.

 

Additionally, 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 DRG will be reimbursed.

 

For additional information, please review the Inpatient Readmission reimbursement policy at https://providers.anthem.com/ky.

 

AKY-NU-0374-21