Harvard Pilgrim’s Inpatient Acute Medical Admissions Payment Policy outlines reimbursement for inpatient acute medical admissions for services rendered at Harvard Pilgrim-contracted facilities and the timeframe for what Harvard Pilgrim considers to be a readmission for diagnosis-related groups (DRGs) and global case rate facilities. Effective Nov. 15, 2017, Harvard Pilgrim is extending this timeframe from 7 days to 30 days.
Under the updated policy, members who are readmitted within 30 days of an inpatient discharge for the same or a related condition for which they were treated during the original admission may be reviewed. If it is determined that the member is being treated for the same or a related condition as the original admission, the readmission will be retracted.
For more information, please refer to Harvard Pilgrim’s updated Inpatient Acute Medical Admissions Payment Policy.