July 10, 2026

Effective Aug. 1, 2026, BlueCross BlueShield of South Carolina will no longer provide separate reimbursement for inpatient readmissions that occur within 30 days of a prior inpatient admission when the subsequent admission is for a clinically related diagnosis and may be considered potentially preventable.

This policy applies to: 

• All South Carolina acute care providers.
• Facilities within the same health system or under the same tax identification number.
• All BCBSSC commercial members.

Please note that Healthy Blue℠ implemented a similar readmission policy effective Jan. 1, 2024.

Reducing avoidable hospital readmissions has been a national healthcare quality initiative for many years. The Centers for Medicare & Medicaid Services (CMS) began focusing on hospital readmissions in 2009, and many commercial health plans have since adopted comparable payment policies to encourage care coordination and improve patient outcomes.

Under this policy, inpatient hospital claims submitted for a readmission occurring within 30 days of a previous inpatient stay may be subject to medical review by BlueCross to determine whether the readmission is clinically related and potentially preventable.

Exceptions to this policy include, but are not limited to: 

• Behavioral health admissions.
• Organ and tissue transplant services.
• Maternity and newborn admissions.
• Transfers between acute care facilities.

Providers are encouraged to review the Inpatient Hospital Readmission Policy available on My Insurance Manager℠ for complete policy details, criteria and applicable exceptions.

Thank you for your continued partnership in improving healthcare quality and outcomes for our members.

Healthy Blue is offered by BlueChoice HealthPlan, an independent licensee of the Blue Cross Blue Shield Association.

CMS is an independent organization that offers health information you might find helpful.