BCN changing inpatient readmission review guidelines starting Jan. 17, 2017

Starting Jan. 17, 2017, BCN is changing the guidelines it uses to review inpatient readmissions of BCN HMO^SM (commercial) and BCN Advantage^SM members for billing purposes. Under the updated guidelines, BCN will combine admissions for members readmitted within 30 days for the same or a related condition whether or not discharge criteria were met.

Currently, the admissions are typically billed separately as long as the member met the discharge criteria and had an appropriate discharge plan, even if the readmission was for a new occurrence of the same condition.

The Guidelines for Bundling Admissions document is being updated to reflect this change. The updated document will be available online prior to Jan. 17.

You can access that document by completing the following steps:

1. Visit bcbsm.com/providers and click Login.
2. Log in as a provider, using your user name and password.
3. Click BCN Provider Publications and Resources.
4. Click Billing / Claims.
5. Click Guidelines for Bundling Admissions.

Posted: November 2016
Line of business: Blue Care Network