Hospital Readmissions Payment Policy Revision

Effective with claim dates of service starting September 5, 2025, unplanned inpatient readmissions that fall within 30 calendar days of discharge for the same condition from the same hospital or hospital system won’t be reimbursed. This policy change only applies to hospitals reimbursed under Diagnostic Related Groups (DRGs). LifeWise will review its readmission policy for hospitals reimbursed under other non-DRG methods later this year.

This policy change doesn’t apply to same-day transfers between hospitals within a 24-hour period from hospital discharge. Same-day transfers are required to be coded correctly using a correct discharge code on the discharging hospital claim and an appropriate admission code for the readmitting hospital. Failure to identify the claim as a same-day transfer may result in the claim being classified as a readmission and denied reimbursement.

The policy also lists a variety of claim category exceptions identified by DRG that aren’t subject to the policy.

Review the details of the policy.