Policy update: Inpatient Readmissions

(Policy G-13001, effective 07/01/22)

 

In the April edition of Provider News, we announced a policy language update to Inpatient Readmission. To clarify the communication, when a member is readmitted within 30 days, as part of a planned readmission and placed on a leave of absence, the admissions are considered to be one admission, and only one diagnosis-related group (DRG) will be reimbursed.

 

In addition, 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 for the same, similar, or related condition. Also, we will not allow payment for the first admission when a member is readmitted for the same or similar diagnosis. 

 

For additional information, please review the Inpatient Readmissions reimbursement policy at Provider Website.

WIBCBS-CD-007058-22