As we announced in last month’s issue of Insights and Updates to Providers, Point32Health wants to remind our provider partners that we are making updates to our Inpatient Hospital Admissions Payment Policy, effective for dates of service beginning June 1, 2025.
With this update — in support of our goal of reducing avoidable readmissions — Point32Health will review claims for members who are readmitted to the same hospital or the same hospital system within 30 days of the original 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 for the same or a related condition as the original admission, the readmission claim payment will be retracted.
This change will apply for claims paid using diagnosis-related group or case rate payment methodology for all Point32Health products. Our Readmission (Bridging of Claims) Payment Policy for Tufts Health Plan Senior Products has also been updated to reflect the new process.