Revenue Cycle

Scenario: Benefit period for a hospital/SNF patient stay

Medicare Update for CAHs, March 21, 2012

Question: A Medicare beneficiary who had never before been hospitalized was admitted to and stayed in a hospital for 58 days (admission 1). The patient was discharged from admission 1 to a skilled nursing facility (SNF) for 14 days. Thirty days after leaving the SNF, the patient was admitted (admission 2) to a hospital for a four-day stay and then discharged to home. All services were provided during 2012. What is the patient’s total hospital deductible and coinsurance liability for admissions 1 and 2, assuming that Medicare covered both admissions?

Answer: $1,156 for acute care hospital days 1-60, plus acute care hospital days 61 and 62 at $289 per day = $1,734.

Note: Although SNF days are counted for calculation of the benefit period, the SNF days have their own coinsurance amount and the 14 days above are not multiplied by the acute care coinsurance amount (i.e. 14 X $289).

This tip was adapted from HCPro’s Medicare Boot Camp® - Critical Access Hospital Version.

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