Inpatient Facility Coding & Compliance Alert

Question: A patient who previously had pneumonia needed to be readmitted to the hospital multiple times for various reasons. Does this have an effect on the hospital’s reimbursement?

Texas Subscriber

Answer: Yes, you are right. Under the Hospital Readmissions Reduction Program, for discharges beginning on or after Oct. 1, 2012, an adjustment is made to the base operating DRG payment to account for excess readmissions. A hospital’s excess readmission ratio is a measure of its readmission performance compared to the national average for its set of patients for each of the following three conditions: Acute myocardial infarction, heart failure, and pneumonia.

A readmission generally refers to an admission to an acute care hospital paid under the IPPS within 30 days of a discharge from the same or another acute care hospital.