BlueSpeak September 2026: Payment Policy Updates

REQUIREMENTS: By October 1, 2026: Billing team must update billing software and claims submission processes for Revenue Code 0710 (Recovery Room) policy. (1) Configure system to reject or flag claims where revenue code 0710 is submitted without a corresponding anesthesia revenue code 037X on the same claim. (2) Update billing procedures to document that revenue code 0710 is only allowed on the day of surgery/procedure for outpatient facilities not using CMS reimbursement methodology. (3) Train billing staff that claims missing the required anesthesia code will be denied for incomplete or incorrect data. By November 1, 2026: Billing team and providers must implement Inpatient Readmissions policy changes. (1) Update billing system logic to identify and combine readmissions within 15 calendar days of discharge to the same health system for related conditions. (2) Configure system to process combined admissions as single payment per hospital contractual agreement rather than submitting separate reimbursement claims. (3) Establish internal communication protocol with clinical teams to flag qualifying readmissions during discharge planning. (4) Train coding and billing staff on "related condition" definitions: same/closely related diagnosis, infection/complication from initial stay, failed intervention, acute exacerbation of chronic condition, or clinical instability at discharge. (5) Update claim submission procedures to bundle these readmissions before sending to Blue KC. Failure to comply will result in denied claims for the second admission or improper reimbursement denials.