How do I report a BlueCard^® inpatient acute care readmission claim?

The same reporting requirement for Blue Cross Blue Shield of Michigan readmission claims applies to BlueCard. If a patient is admitted within 14 days of a previous discharge, the hospital should determine if the two admissions meet our readmission criteria to be billed as a combined claim.

If the admissions should be combined and reported on a single claim, you’ll need to report leave of absence days for the time the patient was out of the hospital. The combined inpatient claim with leave of absence days should be reported as follows:

• Report Value Code 80 for the covered days — the days the patient was in the hospital.
• Report Value Code 81 for the noncovered days — the days the patient wasn’t in the hospital.
• The units reported for revenue code 0180 should equal the number of days the patient wasn’t in the hospital.
• There shouldn’t be any charge reported for revenue code 0180; therefore, report 0.00 for the covered amount.
• There should never be any monetary amount in the noncovered charge for Revenue Code 0180.

 Note: The reporting requirements for readmission claims can be found in the “Claims” chapter of the Inpatient Hospital manual.

For more information on the BlueCard program, including links and articles on online tools, see the BlueCard chapter of the online provider manuals.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.