Reimbursement Policy Update: Inpatient Readmissions

(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