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Updated on April 26, 2021

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.

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