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Reimbursement Policy: Inpatient Readmissions, System Facilities
Effective July 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is updating its Inpatient Readmissions reimbursement policy.
Blue Cross NC’s inpatient readmissions criteria will now apply across all hospitals under the same Facility Agreement or Tax Identification Number (TIN), identified in the policy as “same hospital or system facility”. Readmissions occurring at hospitals within the same system (identified by their Facility Agreement) for the same, similar, or related condition will not be eligible for separate facility reimbursement. Reimbursement will be allowed for the original admission and should not be combined to qualify for outlier reimbursement. Please see the related July 1, 2025, policy notification for more information.
Blue Cross NC is implementing this change in alignment with our mission to make healthcare more affordable for all. We are committed to our members receiving the highest quality of care. By expanding the policy to include hospitals within the same system, we aim to continue identifying inpatient stays that meet readmission criteria and addressing their inappropriate additional reimbursement.
This change will apply to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage (MA) and Federal Employee Program (FEP). This will not apply to IPP Home.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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