Meridian - Provider Readmission Review Notice

June 3, 2019

Effective August 1, 2019, Meridian is implementing updates to Meridian Medical Policy B. 05 Readmission Review. This policy outlines Meridian’s processes of reviewing, adjudicating, and adjusting claims payments for inpatient admissions that are deemed to be potentially preventable readmissions. This policy is in alignment with Michigan Department of Health and Human Services’ Medicaid Provider Manual Readmission, Section 9.2. Meridian Medical Policy B. 05 Readmission Review policy is available on the Meridian website under Training & Education Resources.

Through this process, Meridian will identify claims that are most likely preventable readmissions. The identification is based on billed diagnostic related groupings (DRGs), as well as the same or similar diagnoses found on the two related hospital claims. Upon identification of the claim, Meridian will request medical record documentation to conduct a review of the admission and readmission. This documentation request may include the following and should be returned within seven days of request:

• Emergency room (ER) record/admission record

• History and physical

• Consultations

• Case management notes

• Practitioner orders

• Practitioner progress notes

• Nursing notes

• Diagnostic testing results

• Discharge instructions

• Discharge medication lists

• Operative report

• Discharge summary

Please read the attachment for full details of changes.