PDFWAC 296-23A-0560
How does the department define and pay for hospital readmissions?
The department will review hospital readmissions occurring within seven days of discharge and will determine whether the second admission resulted from premature discharge. Payment for services associated with readmission will depend upon the review. For example:
• | If the second admission is determined unnecessary, reimbursement may be denied. |
• | If the admission was avoidable, the two admissions may be combined and a single diagnosis-related-group (DRG) payment made. |
• | If two different DRG assignments are involved, reimbursement for the appropriate DRG will be based upon review of the case. |
• | Readmissions involving different hospitals will be reviewed by the department and may be paid using the payment method for transfers. |