Harvard Pilgrim has developed an Inpatient Acute Medical Admissions Payment Policy for Medicare Advantage members. The policy outlines how Harvard Pilgrim reimburses inpatient acute medical admissions and manages readmissions for services rendered at contracted facilities.
Under the policy, which is effective for dates of service beginning Sept. 1, 2018, Harvard Pilgrim will review claims for members who are readmitted to the same facility within 30 days of an inpatient discharge for the same or a related condition for which they were treated during the original admission. If it is determined that the member is being treated at the same facility for the same or a related condition as the original admission, Harvard Pilgrim will not provide separate reimbursement for the readmission.
For more information, please refer to Harvard Pilgrim’s new StrideSM (HMO) Medicare Advantage Inpatient Acute Medical Admissions Payment Policy.