Readmission Reviews

Avoid paying for preventable readmissions.

The cost of unnecessary hospital readmissions within 30 days of discharge is staggering.

The Center for Health Information and Analysis (CHIA) estimates the number of readmissions in the U.S. to be 3.8 million annually, at a cost of roughly $26 billion. Moreover, the cost of preventable readmissions is estimated to be a whopping $17 billion annually.

By reviewing hospital readmissions to identify those that could have been prevented, payors can help reduce overpayments and improve payment integrity.

MedReview’s Readmission Review program provides thorough, accurate reviews of targeted readmissions to determine if they were the result of a premature discharge, insufficient discharge planning or lack of post- discharge follow-up.

Only MedReview offers an average per claim savings of


Using artificial intelligence (AI), machine learning (ML) and advanced proprietary algorithms, MedReview identifies select readmission cases from the payor claim file based on DRG codes and dates of service and performs comprehensive reviews to determine whether the readmissions were preventable.

To make its determination, MedReview considers the entirety of the information that was available to the attending physician who discharged the patient after the first admission, as well as the DRG coding from the readmission. If a readmission is deemed to have been avoidable, MedReview will recode and reprice the claim with all diagnoses and procedures from both claims into a single DRG payment – delivering a significant cost savings and helping ensure payment integrity.

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