Update: DRG Readmission Processing implementation

In a December Record article, we wrote about proposed enhancements to Diagnosis Related Group Readmission Processing and asked for facility input. Based on that input, we’re providing some additional information below:

• If a facility is a Peer Group 5, 6 or 7** and is paid per diem (per day) or doesn’t receive DRG payments, then the DRG Readmission Processing does not apply.

• As part of DRG Readmission Processing, we’ll still allow facilities to bill “Against Medical Advice,” or AMA. AMA will be billed as its own claim and wouldn’t be rejected as a readmission.

• Same facility admissions*** to inpatient psychiatric, substance abuse, inpatient and outpatient rehabilitation, as well as skilled nursing facilities, will be individually reimbursed and won’t be considered readmissions. For example, an attached SNF is paid on a case rate, while a freestanding SNF is reimbursed per diem.

Following Blue Cross Blue Shield of Michigan’s review of facility input, we’ll be moving forward with this program, effective March 1, 2022. Details about DRG Readmission Processing were also presented at the Staff Liaison Group’s Jan. 6, 2022, meeting, which included leadership from the Michigan Health and Hospital Association and Blue Cross.

**Peer Group 5 = rural facility, Peer Group 6 = psychiatric facility and Peer Group 7 = rehabilitation facility.

***Admissions to areas within or attached to the same facility where the patient is currently located.