HSCSN Provider Policies

Hospital Readmission Payment Policy

Effective November 6, 2024, HSCSN will no longer provide a separate reimbursement for claims identified as a readmission hospitalization to the same acute care facility and Institutions for Mental Disease (IMD) for the same or similar related conditions within thirty (30) days of the original admission.

HSCSN uses the following standards when evaluating readmissions:

• Admission to the same acute care facility or IMD within 30 days from discharge date of an Original Admission.
• Admission for same or similar DRG (Diagnosis Related Group) groupings.

HSCSN’s exclusionary factors to the inpatient readmission hospitalization may include the following:

1. Discharge from original hospitalization was against medical advice.
2. Readmission was planned for ongoing, intentionally scheduled treatments.
3. Patient transfers from one acute care hospital to another.
4. Involuntary admissions for Behavioral Health.
5. Admissions for the medical treatment of:
   • Cancer
   • Transplant services
   • Obstetrical deliveries
   • Neonatal/Newborn hospitalizations (<1 year of age)
   • Behavioral health admissions for individuals with co-occurring intellectual disabilities
   • Substance Use Disorder

HSCSN will follow the standard appeals process for denial of hospital readmission payments.

For more information on hospital readmissions and exclusions, please contact Customer Care at 202-467-3727.