Readmission Review Saves Customer Millions

October 11, 2022

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Collaboration Leads to Improvement of Internal Claims Auditing

Many healthcare payers have readmission policies in place to help identify reimbursements that should be considered a continuation of a patient’s initial treatment.  

The readmission of a discharged patient can cause inflated medical and administration costs. Nationally, more than 3.8 million medical claims are eligible for readmission review every year*.

Recently, CERIS partnered with a large national payer to identify more than 40 readmission claims per month, each averaging $15,000 in overpayment.  Overall the financial impact exceeded $5 million in readmission charges in the first six months. CERIS worked with the payer to improve their prepayment claim auditing process resulting in an 85% reduction in readmission claims paid. 

CERIS can help you evaluate your readmission program to identify cost containment opportunities and evaluate your policy to ensure it applies to all hospitals and facilities, including those within the same health system.  

To learn more, visit our website or call us at 844-868-0058.

*AHRQ Source 

Let's partner to a clear path to greater accuracy and cost savings.

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