Reimbursement policy: Reminder about inpatient readmissions

As a reminder, Anthem Blue Cross and Blue Shield (Anthem) 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 Centers for Medicare & Medicaid Services (CMS) contracts and/or requirements indicate otherwise.  This is further described in the existing reimbursement policy located at: https://www.anthem.com/medicareprovider.

 

If Anthem Medicare Advantage determines that this reimbursement policy has not been followed, Anthem Medicare Advantage 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 Anthem Medicare Advantage and Anthem Medicare Advantage policies.

 

For more detailed information on the inpatient readmissions reimbursement policy, please visit https://www.anthem.com/provider/policies/reimbursement.

 

ABSCARE-0914-21                   518376MUPENMUB