4. Jane Doe is an 83-year-old patient who has only Medicare Part A insurance. Us

Question

4.   Jane Doe is an 83-year-old patient who has only Medicare Part A insurance. Using the information in table 16.W4 to calculate the patient’s financial responsibility for each hospitalization, and answer the questions regarding her listed hospitalizations.

Table 16.W4.

Date Admitted

Date Discharged

Patient’s Financial Responsibility

01/01

01/13

$1,024

03/20

03/30

$1,024

07/04

11/02

$24,576 ($1,024 + 7,680 + 15,872)

12/01

12/05

$2,560

a. How many benefit periods were used during this calendar year?

b. Were any lifetime reserve days used during this period of time? If so, how many?

c. If lifetime reserve days were used, how many does the patient have left to be used at a later date?

d. How many times was the patient required to pay a hospital deductible during this time period?

5.   Following the last hospital admission, Jane was transferred to a skilled nursing facility (SNF) and remained there for continued treatment for 22 days.

a. How much was Jane required to pay for her SNF care for days 1 through 20?

b. How much was she required to pay for the remainder of her SNF stay?

6.   After Jane’s discharge from the skilled nursing 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?

Date Admitted

Date Discharged

Patient’s Financial Responsibility

01/01

01/13

$1,024

03/20

03/30

$1,024

07/04

11/02

$24,576 ($1,024 + 7,680 + 15,872)

12/01

12/05

$2,560

Explanation / Answer

4 a) Benefit period startes from the day you go into hospital and ends when you are out from hospital and the benefit is valid for 90 days. There are unlimited benefit periods and the deductible is cut for each benefit period. Here Jane has used three benefit periods. The first hospitalisation was in January and she was discharged after 12 days. Again she went in in March and stayed for 10 days. The 90 days benefit period had started in Jan and was supposed to end in April 1st. So the second hospitalisation also got covered in the first benefit period. The second benefit period started in July and the stay was for more than 90 days. The third benefit period started for the hospital stay in December.

b) Lifetime reserve days were used in the third stay in July. Benefit period is valid for 90 days and lifetime reserve days are a total of 60 days which can be used post the benefit period. So these days were used for third hospital stay. 28 days of life time reserve days were used.

c) Out of 60, 32 reserve days are left to be used.

d) The patient was supposed to pay the deductible three times.

Related Questions

Navigate

• Browse (All)
• Browse 4
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.