Policy reminder: Inpatient Readmissions

As a reminder, Empire BlueCross BlueShield (Empire) Medicare Advantage does not allow separate reimbursement for claims that have been identified as a readmission to the same hospital for the same, similar or related condition unless provider, federal, or CMS contracts and/or requirements indicate otherwise as further described in the existing reimbursement policy found here: https://www.empireblue.com/da/inline/pdf/67389musenmub_ebcbs.pdf.

 

If Empire determines that this reimbursement policy has not been followed, Empire may deny the claim prior to payment or recover any paid claim. Providers may dispute any claim denied under this policy consistent with applicable law, your agreement with Empire, and Empire policies.

 

For more detailed information on the Inpatient Readmissions reimbursement policy, please visit https://www.empireblue.com/provider/policies/reimbursement/.

 

EBSCRNU-0180-21 June 2021

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