Question

Jane Doe is an 83-year-old patient who only has Medicare Part A insurance. Using the 4. following information, calculate the patient's financial responsibil ity for each hospitalization and answer the questions regarding her listed hospitalizations: Table W 7.W4 DATE ADMITTED DATE DISCHARGED PATIENT'S FINANCIAL RESPONSIBILITY 01/01 01/13 $1,024 $1,024 $24,576 ($1,024 +7,680+15,872) $2,560 03/20 03/30 07/04 11/02 12/01 12/05 How many benefit periods were used during this calendar year? а. b. Were any lifetime reserve days used during this period of time? If so, how many? If lifetime reserve days were used, how mary does the patient have left to be used at a later date? с. How many times was the patient required to pay a hospital deductible during this time period? d. Following the last hospital admission, Jane was transferred to a skilled nursing facility (SNF) and remained there for continued treatment for 22 days 5. How much was Jane required to pay for her SNF care for days 1-20? a. How much was she required to pay for the remainder of her SNF stay? b. After Jane's discharge from the skilled facility, she received home health care as prescribed by her physician for 14 days. During this time period, she met all of Medicare's medical necessity criteria for her care. How much was Jane required to pay for her home health care? 6. en

Answer 1

1. Benefit period starts when you go into the hospital and end when you have been out for 60 days in 1 row. If you go back to hospital after 60 days, a new benefit period starts.

Date Admitted	Date Discharged	Patient’s Financial Responsibility	Days of stay	Admission gap
1-Jan	13-Jan	$1,024	12
20-Mar	30-Mar	$1,024	10	66
4-Jul	2-Nov	$24,576 ($1,024 + 7,680 + 15,872)	121	96
1-Dec	5-Dec	$2,560	4	29

So here we can see that for 2 times the admission gap has been more than 60 days. So, there are 3 benefit period. Date admitted on 1st Jan, 20- Mar and 4 July. Admission gap on 1st Dec is not a benefit period as it is less than 60 days.

2. Medicare Part A covers an unlimited number of benefit periods, and it helps pay for up to 90 days of care for each one. Lifetime reserve are the extra 60 days provided beyond 90 days After 90 days, it’s possible to tap into lifetime reserve days.

So in the period of 4th July to 2nd Nov Jan was hospitalized for 96 days. So she has used lifetime reserve of (96-90=6 days).

3. Since the lifetime reserve of 6 days has been used and lifetime reserve days allowed is 60 days so the patient has 60-6=54 days left of timetime reserve.

4.At the beginning of each benefit period, the Medicare Part A deductible must be paid by beneficiaries. Here as we know the benefit period is 3 so the patients should pay deductibles for 3 times.