Point32Health is updating our policy related to the reimbursement of pre-admission testing for inpatient admissions, effective for dates of service beginning July 1, 2025.
For contracted hospitals reimbursed based on diagnosis-related groups (DRGs) or at a global case rate, payment for pre-admission services that occur within 10 days of an admission (as opposed to the current timeframe of three days) will be included in the inpatient reimbursement and will not be reimbursed separately.
We’ve updated our Inpatient Hospital Admissions Payment Policy to reflect this change. For DRGs and global-case-rate-contracted hospitals, the policy specifies the following regarding pre-admission testing services, which may be subject to random post-payment audits and retraction:
- Diagnostic services that are provided within 10 days of an inpatient admission are included in the inpatient reimbursement.
- Non-diagnostic services related to the principal diagnosis that are provided within 10 days of an inpatient admission are included in the inpatient reimbursement.
- Any ambulatory day care, radiology or laboratory procedures that result in an inpatient admission are included in the inpatient DRG reimbursement.
Please refer to the updated policy for more information.