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What counts as a readmission under the hospital readmissions reduction program This is a denial in which payment is denied for a hospital stay that is within 30 days of a previous hospital stay. In reviewing the medicare regulations related to the hrrp, there is no statutory and/or regulatory requirement that the private medicare managed care plan outright deny claims for readmissions if they occur within 30 days of the original claim.
Fujisaki Akane - Maou-sama Retry! - Image by Gekkou (Studio) #4278123
Try to make it clear that early discharge did not play a role in a readmission Perhaps the most annoying and frustrating for me is the “30 day readmission” denial Many complications or exacerbations will occur simply due to the nature of the disease process despite your great care measures to prevent them.
When a readmission is expected but the date of readmission is different from that initially planned, the readmission should still be treated as a leave of absence, with one claim and one combined drg payment.
Managed medicare companies cite the centers for medicare & medicaid services (cms) readmission policy as the basis for their denials Cms instructs hospitals to combine for billing purposes when a patient is readmitted on the same calendar day for the same or a similar diagnosis. A readmission is defined as a return hospitalization to an acute care hospital that follows a prior acute care admission within thirty (30) days, or the number of days specified in the provider contract, of discharge for a clinically related admission. Eason for admission should be excluded from the readmission measures
Although the aca requires that unrelated readmissions be excluded from the program, cms has not fully implemented this policy For example, a patient may be hospitalized for pneumonia, and then readmitted within 30
