In executing the hospital readmission audit, Smart Claims Engine for Healthcare leverages CMS’ definition of an unplanned hospital readmission, including:
- A 30-day look-back period for unplanned hospital readmissions.
- Application of readmission rules to short-stay, acute hospitals.
- Certain hospitals types are excluded based on taxonomy.
- Exclusion of certain planned admissions, based on procedures and diagnoses.
Smart Claims Engine for Healthcare executes the hospital readmission audit logic in the CE_HospitalReadmissions collection, in the CE_BusinessAudits adjudication module.