Medicare AdvantageReimbursementHigh impact
Mutual News June 2024 Bulletin
Medical Mutual of Ohio·Emergency Medicine, Critical Care·Mutual News Bulletin
Effective date
Sep 18, 2024
We identified it
Jun 20, 2026
Summary
Medical Mutual is splitting hospital readmission policies by plan type, with expanded readmission reviews for Medicare Advantage plans starting September 18, 2024. The policy will now review observation stays and inpatient readmissions more broadly, with associated observation charges being denied when readmissions are denied.
Action Required
By September 18, 2024: Hospital billing teams must update readmission review processes to distinguish between Medicare Advantage and non-Medicare Advantage plans. For Medicare Advantage, prepare for expanded reviews covering observation-to-inpatient, inpatient-to-observation, and observation-to-observation readmissions. Update billing systems to flag that observation charges will be automatically denied when related readmissions are denied. Review Provider Manual sections 9 and 12 for detailed changes.