Aetna’s new “level of severity inpatient payment” Medicare policy is now set to kick off next year instead of Nov. 15, according to a Nov. 6 company document.
As part of the reimbursement approach, Aetna will approve inpatient stays without a medical necessity review and cover the claim at a lower level of severity rate that aligns with observation services. When a stay meets Aetna’s supplemental guidelines for inpatient admissions, Aetna will pay in accordance with the hospital agreement. The policy would apply to affiliated Medicare facilities.
Aetna’s latest update outlined that the level of severity review will only apply to urgent/emergent inpatient stays of at least one midnight but fewer than five. Longer stays will not be subject to the review and will be paid at the inpatient diagnosis-related group rate. For stays that neither fit the timeline guidance nor supplemental guidelines for inpatient admissions, providers can request a severity review and discuss with an Aetna medical director.
The policy’s other provisions remain the same.
The changes follow pushback from the American Hospital Association over the policy. AHA President and CEO Richard Pollack expressed concerns over how the policy could skew Aetna’s Medicare Advantage Star Ratings and how hospitals will tackle disputes.
