Here is a quick review of our hospital Readmission Audit Program

Blue Cross Blue Shield of Michigan conducts audits for patients readmitted to a hospital within 14 days of a previous discharge. There are two types of readmission audits:

• Desk — The facility submits a patient’s health information record to Blue Cross by secure, electronic media, disc or paper for the review.
• Onsite — The readmission team members are on-site at the facility and review the patient’s record.

Key steps in the readmission audit process:

• At the beginning of the year, the hospital will be notified by mail it’s selected for an audit.
• About 30 days before the audit, the lead auditor will contact you to confirm the audit date and hospital contact information.
• After confirming the audit appointment, you’ll receive the case list of readmissions identified for the audit. Once you’ve receive the case list, no adjustments should be made to the patients’ claims.
• When the audit is complete, the lead auditor will forward a copy of the audit report, which includes the approval and non-approval readmission report, to the designated hospital contacts.
• Decide whether to appeal, or not, and submit your response to Blue Cross.

Hospitals may appeal cases in writing no later than 50 days from the receipt of the audit report. Send your written appeal to:

Utilization Review Appeals
Attn: Rhonda Thomas, Manager
Mail Code 616A
Blue Cross Blue Shield of Michigan
600 E. Lafayette Blvd, Detroit, MI 48226

If your facility decides not to appeal, please send notification within five days of receiving your audit report letter, by fax, to our Utilization Review department at 1-877-276-3920.

For more information, see your online provider manual.