Guest guest Posted January 6, 2004 Report Share Posted January 6, 2004 Can anyone help me understand what it means when someone is out of Medicare days and if someone is out of Medicare days when/how can they get them back?? [(Aguiar, )] I had posted this awhile back in response to a similar question posted by another member & I think it covers most of what you're asking. Please keep in mind, though, that the amounts referenced aren't applicable today & off the top of my head, I don't know what the new ded's are, but the gist of ow Medicare days work remains the same. Hope it helps, J. Aguiar Beth Israel Deaconess, Boston Here's another M'care question: is there a lifetime max on Medicare?[(Aguiar, )] Not in the way you're thinking. You need to firstkeep in mind there are actually 2 components to Medicare which haveabsolutely NO impact on each other-Part A & Part B. In other words, denied charges or deductibles from Part A do not get rolled into Part B. Medicare Part B pays for MD services, outpt charges, & post-tximmunos. It is a standard 80-20 plan w/a one-time per calendar year deductible of $100. No calendar year or life max on Part B services. Medicare Part A ONLY covers inpt services. For an acutehospital stay, the benefits are as follows: Day 1-60 covered @ 100% UCR after an initial deductible of$792. These are aka "full ins days". Day 61-90 covered @ 100% UCR after $198 PER DAY deductible. These are the "co-ins" days. Day 91-150 covered @ 100% UCR after $396 PER DAY deductible. These are the "lifetime reserve" days. Unlike the full ins & co-ins days,lifetime reserve (aka LTR days) are non-renewable. Medicare requires that the pt be notified when he/she goes into LTR days & must sign a formacknowledging this. Once in a while there is a Medicare supplement plan which doesn't require the pt to use those day, but they are becoming few & far between. Medicare Part A also provides 100 days of coverage in a Skilled Nursing Facility (SNF) w/a daily deductible on days 21-100. These days are apart from the 150 acute hospital days. After day 150, there are no more Medicare Part A benefitsallowed until the pt has started a new benefit period. This starts after the pthas been d/c from both the acute hospital, acute rehab, & /or skilled nursingfacility (SNF) for 60 consecutive days. However, keep in mind, if the pt usedsome or all of his/her LTR days, those days WILL NOT RENEW themselvesEVER. The pt will have the 60 full, 30 co, & however many LTR days haven't been used available on the next benefit period. Probably someone in your admitting office has the lucky job ofkeeping track of how many days your Medicare population has used, though since you work for a Children's hospital, it's not as cumbersome as it is in a facility like mine which has a higher % of Medicare beneficiaries. Ifyou're worried about your pt benefit exhausting, check w/the Admittingsupervisor to see who's following this & where exactly the pt stands.Whomever follows the days will also be checking, as the timeapproaches, to see what coverage the secondary ins provides when they become prime due to Medicare benefit exhaust. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2004 Report Share Posted January 6, 2004 FYI – the 2004 Medicare amounts have changed. IP deductible - $876 Coinsurance - $219 / day LTR - $438 / day The coinsurance amount is 25% of the IP deductible and the LTR amount is 50% of the IP deductible. The Part B deductible is still $100, but the premium has gone up to $66.60 / month. Sue Weber Heart & Liver Transplant Financial Coordinator The Methodist Hospital Houston, Texas Phone : 713/790-5964 FAX : 713/790-3041 Email : sweber@... -----Original Message----- From: LAguiar@... Sent: Tuesday, January 06, 2004 7:04 AM To: TxFinancialCoordinators Subject: RE: Medicare Days Can anyone help me understand what it means when someone is out of Medicare days and if someone is out of Medicare days when/how can they get them back?? [(Aguiar, )] I had posted this awhile back in response to a similar question posted by another member & I think it covers most of what you're asking. Please keep in mind, though, that the amounts referenced aren't applicable today & off the top of my head, I don't know what the new ded's are, but the gist of ow Medicare days work remains the same. Hope it helps, J. Aguiar Beth Israel Deaconess, Boston Here's another M'care question: is there a lifetime max on Medicare? [(Aguiar, )] Not in the way you're thinking. You need to first keep in mind there are actually 2 components to Medicare which have absolutely NO impact on each other-Part A & Part B. In other words, denied charges or deductibles from Part A do not get rolled into Part B. Medicare Part B pays for MD services, outpt charges, & post-tx immunos. It is a standard 80-20 plan w/a one-time per calendar year deductible of $100. No calendar year or life max on Part B services. Medicare Part A ONLY covers inpt services. For an acute hospital stay, the benefits are as follows: Day 1-60 covered @ 100% UCR after an initial deductible of $792. These are aka " full ins days " . Day 61-90 covered @ 100% UCR after $198 PER DAY deductible. These are the " co-ins " days. Day 91-150 covered @ 100% UCR after $396 PER DAY deductible. These are the " lifetime reserve " days. Unlike the full ins & co-ins days, lifetime reserve (aka LTR days) are non-renewable. Medicare requires that the pt be notified when he/she goes into LTR days & must sign a form acknowledging this. Once in a while there is a Medicare supplement plan which doesn't require the pt to use those day, but they are becoming few & far between. Medicare Part A also provides 100 days of coverage in a Skilled Nursing Facility (SNF) w/a daily deductible on days 21-100. These days are apart from the 150 acute hospital days. After day 150, there are no more Medicare Part A benefits allowed until the pt has started a new benefit period. This starts after the pt has been d/c from both the acute hospital, acute rehab, & /or skilled nursing facility (SNF) for 60 consecutive days. However, keep in mind, if the pt used some or all of his/her LTR days, those days WILL NOT RENEW themselves EVER. The pt will have the 60 full, 30 co, & however many LTR days haven't been used available on the next benefit period. Probably someone in your admitting office has the lucky job of keeping track of how many days your Medicare population has used, though since you work for a Children's hospital, it's not as cumbersome as it is in a facility like mine which has a higher % of Medicare beneficiaries. If you're worried about your pt benefit exhausting, check w/the Admitting supervisor to see who's following this & where exactly the pt stands. Whomever follows the days will also be checking, as the time approaches, to see what coverage the secondary ins provides when they become prime due to Medicare benefit exhaust. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2004 Report Share Posted January 6, 2004 Thanks, Sue! RE: Medicare Days Can anyone help me understand what it means when someone is out of Medicare days and if someone is out of Medicare days when/how can they get them back?? [(Aguiar, )] I had posted this awhile back in response to a similar question posted by another member & I think it covers most of what you're asking. Please keep in mind, though, that the amounts referenced aren't applicable today & off the top of my head, I don't know what the new ded's are, but the gist of ow Medicare days work remains the same. Hope it helps, J. Aguiar Beth Israel Deaconess, Boston Here's another M'care question: is there a lifetime max on Medicare? [(Aguiar, )] Not in the way you're thinking. You need to first keep in mind there are actually 2 components to Medicare which have absolutely NO impact on each other-Part A & Part B. In other words, denied charges or deductibles from Part A do not get rolled into Part B. Medicare Part B pays for MD services, outpt charges, & post-tx immunos. It is a standard 80-20 plan w/a one-time per calendar year deductible of $100. No calendar year or life max on Part B services. Medicare Part A ONLY covers inpt services. For an acute hospital stay, the benefits are as follows: Day 1-60 covered @ 100% UCR after an initial deductible of $792. These are aka " full ins days " . Day 61-90 covered @ 100% UCR after $198 PER DAY deductible. These are the " co-ins " days. Day 91-150 covered @ 100% UCR after $396 PER DAY deductible. These are the " lifetime reserve " days. Unlike the full ins & co-ins days, lifetime reserve (aka LTR days) are non-renewable. Medicare requires that the pt be notified when he/she goes into LTR days & must sign a form acknowledging this. Once in a while there is a Medicare supplement plan which doesn't require the pt to use those day, but they are becoming few & far between. Medicare Part A also provides 100 days of coverage in a Skilled Nursing Facility (SNF) w/a daily deductible on days 21-100. These days are apart from the 150 acute hospital days. After day 150, there are no more Medicare Part A benefits allowed until the pt has started a new benefit period. This starts after the pt has been d/c from both the acute hospital, acute rehab, & /or skilled nursing facility (SNF) for 60 consecutive days. However, keep in mind, if the pt used some or all of his/her LTR days, those days WILL NOT RENEW themselves EVER. The pt will have the 60 full, 30 co, & however many LTR days haven't been used available on the next benefit period. Probably someone in your admitting office has the lucky job of keeping track of how many days your Medicare population has used, though since you work for a Children's hospital, it's not as cumbersome as it is in a facility like mine which has a higher % of Medicare beneficiaries. If you're worried about your pt benefit exhausting, check w/the Admitting supervisor to see who's following this & where exactly the pt stands. Whomever follows the days will also be checking, as the time approaches, to see what coverage the secondary ins provides when they become prime due to Medicare benefit exhaust. _____ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2004 Report Share Posted January 6, 2004 New Medicare Premiums for 2004 are: Part A:$876.00, Part B:$66.60 per News Release dated Thursday, 10-16-2003, for more info you can contact: CMS Public Affairs Office (202)690-6145. Hope this helps. Joyce Royall >>> LAguiar@... 01/06/04 06:03AM >>> Can anyone help me understand what it means when someone is out of Medicare days and if someone is out of Medicare days when/how can they get them back?? [(Aguiar, )] I had posted this awhile back in response to a similar question posted by another member & I think it covers most of what you're asking. Please keep in mind, though, that the amounts referenced aren't applicable today & off the top of my head, I don't know what the new ded's are, but the gist of ow Medicare days work remains the same. Hope it helps, J. Aguiar Beth Israel Deaconess, Boston Here's another M'care question: is there a lifetime max on Medicare? [(Aguiar, )] Not in the way you're thinking. You need to first keep in mind there are actually 2 components to Medicare which have absolutely NO impact on each other-Part A & Part B. In other words, denied charges or deductibles from Part A do not get rolled into Part B. Medicare Part B pays for MD services, outpt charges, & post-tx immunos. It is a standard 80-20 plan w/a one-time per calendar year deductible of $100. No calendar year or life max on Part B services. Medicare Part A ONLY covers inpt services. For an acute hospital stay, the benefits are as follows: Day 1-60 covered @ 100% UCR after an initial deductible of $792. These are aka " full ins days " . Day 61-90 covered @ 100% UCR after $198 PER DAY deductible. These are the " co-ins " days. Day 91-150 covered @ 100% UCR after $396 PER DAY deductible. These are the " lifetime reserve " days. Unlike the full ins & co-ins days, lifetime reserve (aka LTR days) are non-renewable. Medicare requires that the pt be notified when he/she goes into LTR days & must sign a form acknowledging this. Once in a while there is a Medicare supplement plan which doesn't require the pt to use those day, but they are becoming few & far between. Medicare Part A also provides 100 days of coverage in a Skilled Nursing Facility (SNF) w/a daily deductible on days 21-100. These days are apart from the 150 acute hospital days. After day 150, there are no more Medicare Part A benefits allowed until the pt has started a new benefit period. This starts after the pt has been d/c from both the acute hospital, acute rehab, & /or skilled nursing facility (SNF) for 60 consecutive days. However, keep in mind, if the pt used some or all of his/her LTR days, those days WILL NOT RENEW themselves EVER. The pt will have the 60 full, 30 co, & however many LTR days haven't been used available on the next benefit period. Probably someone in your admitting office has the lucky job of keeping track of how many days your Medicare population has used, though since you work for a Children's hospital, it's not as cumbersome as it is in a facility like mine which has a higher % of Medicare beneficiaries. If you're worried about your pt benefit exhausting, check w/the Admitting supervisor to see who's following this & where exactly the pt stands. Whomever follows the days will also be checking, as the time approaches, to see what coverage the secondary ins provides when they become prime due to Medicare benefit exhaust. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 6, 2004 Report Share Posted January 6, 2004 The home page at www.Medicare.gov ,which is the web site for Medicare consumers, always has the new Medicare deductibles and co-pay information at the end of the current calendar year for the next year. Fred Forsthoffer, MBA Financial Analyst Banner Good Samaritan Transplant Services Ph: ; Fax: RE: Medicare Days New Medicare Premiums for 2004 are: Part A:$876.00, Part B:$66.60 per News Release dated Thursday, 10-16-2003, for more info you can contact: CMS Public Affairs Office (202)690-6145. Hope this helps. Joyce Royall >>> LAguiar@... 01/06/04 06:03AM >>> Can anyone help me understand what it means when someone is out of Medicare days and if someone is out of Medicare days when/how can they get them back?? [(Aguiar, )] I had posted this awhile back in response to a similar question posted by another member & I think it covers most of what you're asking. Please keep in mind, though, that the amounts referenced aren't applicable today & off the top of my head, I don't know what the new ded's are, but the gist of ow Medicare days work remains the same. Hope it helps, J. Aguiar Beth Israel Deaconess, Boston Here's another M'care question: is there a lifetime max on Medicare? [(Aguiar, )] Not in the way you're thinking. You need to first keep in mind there are actually 2 components to Medicare which have absolutely NO impact on each other-Part A & Part B. In other words, denied charges or deductibles from Part A do not get rolled into Part B. Medicare Part B pays for MD services, outpt charges, & post-tx immunos. It is a standard 80-20 plan w/a one-time per calendar year deductible of $100. No calendar year or life max on Part B services. Medicare Part A ONLY covers inpt services. For an acute hospital stay, the benefits are as follows: Day 1-60 covered @ 100% UCR after an initial deductible of $792. These are aka " full ins days " . Day 61-90 covered @ 100% UCR after $198 PER DAY deductible. These are the " co-ins " days. Day 91-150 covered @ 100% UCR after $396 PER DAY deductible. These are the " lifetime reserve " days. Unlike the full ins & co-ins days, lifetime reserve (aka LTR days) are non-renewable. Medicare requires that the pt be notified when he/she goes into LTR days & must sign a form acknowledging this. Once in a while there is a Medicare supplement plan which doesn't require the pt to use those day, but they are becoming few & far between. Medicare Part A also provides 100 days of coverage in a Skilled Nursing Facility (SNF) w/a daily deductible on days 21-100. These days are apart from the 150 acute hospital days. After day 150, there are no more Medicare Part A benefits allowed until the pt has started a new benefit period. This starts after the pt has been d/c from both the acute hospital, acute rehab, & /or skilled nursing facility (SNF) for 60 consecutive days. However, keep in mind, if the pt used some or all of his/her LTR days, those days WILL NOT RENEW themselves EVER. The pt will have the 60 full, 30 co, & however many LTR days haven't been used available on the next benefit period. Probably someone in your admitting office has the lucky job of keeping track of how many days your Medicare population has used, though since you work for a Children's hospital, it's not as cumbersome as it is in a facility like mine which has a higher % of Medicare beneficiaries. If you're worried about your pt benefit exhausting, check w/the Admitting supervisor to see who's following this & where exactly the pt stands. Whomever follows the days will also be checking, as the time approaches, to see what coverage the secondary ins provides when they become prime due to Medicare benefit exhaust. Quote Link to comment Share on other sites More sharing options...
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