HCA Implements Potentially Preventable Readmission (PPR) Adjustments
January 13, 2016
The purpose of this bulletin is to inform Prospective Payment System (PPS) hospitals of changes to their Medicaid inpatient hospital payment rates effective January 1, 2016 due to changes to the Health Care Authority’s policy on paying for readmissions. HCA is replacing its existing policy of reviewing and denying individual readmission claims with a policy that uses a software program to compare each hospital’s rate of potentially preventable readmissions (PPR) rate with an expected rate based on the state’s general experience and the hospital’s mix of cases. Hospitals with higher than expected potentially preventable readmissions are subject to a penalty reduction applied to their inpatient payment rate.... Read More >>