Hospital Readmission Payment Policy

April 2021

Neighborhood updated its Hospital Readmission Payment Policy to include a procedure for reevaluation of an initial payment decision.  Effective January 1, 2021, any facility may request a reevaluation of Neighborhood’s payment decision within sixty (60) days of the receipt of remittance advice. The facility must follow the process detailed in the policy and submit a Readmission Reevaluation Request Form.

The Hospital Readmission Payment Policy is applicable to all in-network facilities for readmissions that have occurred within thirty (30) calendar days of a previous discharge within the same hospital. Neighborhood shall conduct a medical records review to determine if the subsequent hospital admission is related to the previous hospital admission. Readmissions determined to be related to the previous admission will not be reimbursed. The Hospital Readmission Payment Policy applies to all lines of business (Medicaid, Commercial, and INTEGRITY), and types of acute care admissions. In the instance of multiple readmissions, each admission will be reviewed against criteria relative to the immediate preceding admission.

All Neighborhood payment polices, including the Hospital Readmission Payment Policy, can be found on the Neighborhood website in the Billing Guidelines and Payment Policies section.