Hospital inpatient readmissions within 30 days
If a facility determines the readmission should be reimbursed, submit medical documentation to Health Management for review of potential additional payment.
- All admissions are reviewed for medical necessity.
- Determinations for approval or denial made based on InterQual® guidelines and/or a Medical Director decision.
- Readmissions within 30 days (unless otherwise stated in the facility contract) of discharge are denied and considered a part of the original admission. The readmission however, may be appealed by the facility based on readmission guidelines and/or contract.
- Medicaid will continue with 15 day readmissions.
- Same-day readmissions are considered a continuation of care and one claim should be submitted.
Payment guidelines for readmissions
Go to the chart showing how these readmissions will be paid.
