UPDATED: BCN will review inpatient readmissions occurring within 30 days of discharge effective October 1
This story is updated to show that the effective date for this change is Oct. 1, 2016, not Sept. 1, 2016, as reported earlier.
BCN reviews inpatient readmissions from facilities reimbursed by diagnosis-related groups when the member is readmitted with the same or a similar diagnosis.
What's changing? Effective Oct. 1, 2016, BCN will review readmissions that occur within 30 days of discharge. Currently, readmissions that occur within 14 days of discharge are reviewed.
A determination is made as to whether the readmission should be billed separately or bundled with the previous admission. In some instances, the two admissions are combined into one for purposes of DRG reimbursement.
Documents will be updated. The documents listed below will be updated to reflect the change to 30 from 14 days. All of the revised documents will be available online by the end of September:
- Guidelines for bundling admissions
- The Care Management and Claims chapters of the BCN Provider Manual
- The readmission checklist, which facilities should use to ensure that all necessary documentation is available for the review of a readmission that has occurred within 30 days
For additional information, you can access all these documents by completing the following steps:
- Visit bcbsm.com/providers and click Login.
- Log in to Provider Secured Services using your user ID and password.
- Click BCN Provider Publications and Resources.
- Click either Billing/Claims, Provider Manual or Forms, to open the appropriate Web page.
Posted: August 2016
Line of business: Blue Care Network