Posted in #unitedhealthcare, Updates

UHC: Inpatient Readmission Review Policy, Facility-new 09/1/2021

This policy will be applied to UHC commercial Facility claims, starting for DOS 09/01/2021 and thereafter.

The following guidelines will apply:

1.The same day readmissions with same or related condition are required to be combined and reported on the same institutional claim (UB04-claim form or electronic equivalent) to be eligible for reimbursement

2. Same day readmissions with unrelated condition are required to be reported with condition code B4 on the institutional claim in order to be eligible for reimbursement

3. Planned readmissions or leave of absences, are required to be combined and reported on the same institutional claim with occurrence code 74 to report the dates the leave began and ended.

Exceptions to this policy:

  • Admissions for chemotherapy or immunotherapy treatment
  • Admissions for substance abuse unit or facility
  • Admonitions to an inpatient rehab unit
  • Readmissions after a patient is discharged from hospital against medical advice

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Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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