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From The Appeals Desk: The “30 Day Readmission” Denial
This denial is perhaps the most frustrating denial with which I have to contend
Insurance company denials are terribly frustrating. They delay prompt processing of claims. They require annoying extra steps to get paid. And, frequently, they require spending more money on denial and appeal experts such as myself to help fight them. Yes, I’m grateful for the business, and I share the frustration of hospitals and health systems all the same.
In previous articles, we have been discussing the various different types of reasons insurance companies deny payment for services rendered by hospitals to their patients. Perhaps the most annoying and frustrating for me is the “30 day readmission” denial. This is a denial in which payment is denied for a hospital stay that is within 30 days of a previous hospital stay. The allegation is that the patient was inappropriately discharged from the previous hospital stay, and thus the subsequent stay should be considered part and parcel of the first, what we call the “index,” hospitalization. I have seen these denials come through even with hospital stays three weeks later, even for a different reason.
Now, the Centers for Medicare and Medicaid Services, affectionately known as CMS, also penalizes hospitals for excess…
