Department of Health
Medicaid Payments for Hospital Readmissions In New York State’s Medicaid program, medical providers submit claims to be reimbursed for their eligible medical services. When a Medicaid recipient is readmitted to a hospital after recently being discharged from that hospital, the hospital is supposed to combine its reimbursement claims for the initial admission and subsequent readmission to avoid duplicate billing. However, when we reviewed a sample of claims for hospital admissions and related readmissions, we found that the claims often were not combined in accordance with requirements, and as a result, significant overpayments were made.
In addition, when we compared New York’s Medicaid policies on such readmission claims to the policies in other states, we found that New York could realize significant savings if it modified its policies and adopted some of the policies that are used in other states. For example, we estimated that, during our 5.5 year audit period, New York could have reduced its Medicaid expenditures by about $53 million if it had adopted certain aspects of the readmission policy used in New Jersey. We further noted that, during this period, New York also could have realized additional savings of up to $74.5 million if it had subjected its readmissions claims to a more thorough review. We recommended that certain changes be made in New York’s processing of Medicaid hospital readmission claims.
For a complete copy of Report 2009-S-28 click here.
For a copy of the 90-day response click here.