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Add lifetime reserve days to your list of top audit priorities

Health Care Auditing Strategies, October 1, 2005

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A patient lies in a hospital intensive care unit. Her coma has lasted for 85 days-nearly three months.

To the patient's case manager, the task ahead will be challenging. She must inform visiting family members that their loved one's regular Medicare coverage will end five days from now.

This is the type of situation healthcare facilities face every year. Medicare covers as many 90-day episodes as a patient incurs over a lifetime-as long as those episodes are separated by 60 days or more. Anyone requiring care beyond 90 days for a single episode is still entitled to another 60 days, but these extra days are only good once in a lifetime-hence the term "lifetime reserve days."

It's up to hospitals to tell patients or their representatives when regular-care days are about to run out and present the option of using lifetime reserve days. Otherwise, patients or their loved ones may be hit with large, unexpected medical bills. For lifetime reserve days, the beneficiary pays 50% of the benefit period deductible as a daily copayment.

This is an excerpt from a member only article. To read the article in its entirety, please login.

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