REMINDER: BCN will review inpatient readmissions occurring within 30 days of discharge effective Oct. 1, 2016
As a reminder, 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.
Questionnaires in the e-referral system. The questionnaires you'll encounter in the e-referral system will reflect the 14-day time frame for awhile. Updated questionnaires that reflect the new 30-day time frame will be available in the e-referral system in the near future. We suggest you answer the existing questionnaires with the 30-day time frame in mind, even though they refer to a 14-day time frame.
Documents are being updated. The documents listed below are being updated to reflect the change to 30 from 14 days. All of the revised documents will be available online by Sept. 30.
- 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
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: September 2016
Line of business: Blue Care Network