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Error JX
Medium UrgencyNICU Readmission Billing Error
NICU readmission within 48 hours was billed incorrectly. The day count must continue from the previous stay.
Official Description: When a patient is readmitted to NICU within 48 hours, billing continues at the same rate as if there were no break, unless there is a change in acuity level.
How to Fix It
Follow these steps in order to resolve the error.
- Review the patient's NICU admission and discharge history. Confirm if this admission occurred within 48 hours of a previous NICU discharge.
- If the readmission was within 48 hours, calculate the correct billing day. The day count must continue from the previous admission (e.g., if the prior stay ended on Day 5, this admission begins on Day 6).
- Check the physician's notes for a documented change in acuity level upon readmission. A significant change may justify restarting the billing at Day 1.
- Correct the fee item on the claim to reflect the continuous day count. If acuity changed, add a note record to the claim justifying the reset to Day 1.
- Resubmit the corrected claim to Teleplan.
- If the claim is rejected again after correction, contact the Teleplan Data Centre at 604-683-7151 for clarification on this specific case.