Under diagnosis related group (DRG) reimbursement, hospitals are required to submit regular clinical updates to Independence on members undergoing inpatient care.
Beginning November 2, 2020, the frequency of clinical updates needed for Medicare Advantage inpatient stays will change, and hospitals will only need to send Independence clinical updates on day 14 of the member’s inpatient stay and every 14 days thereafter. In some cases, a member’s care may require more frequent updates.
These clinical updates help us ensure that the length of a member’s hospitalization is appropriate. They also promote collaboration with hospitals to establish timely discharge plans and case management referrals.
While these ongoing reviews are concurrent, Independence will continue to review authorizations on a post-pay basis. Itemized bills and medical records may be requested for this review.