Medicare Secondary Payment Where VA Authorizes Fewer

50.1.2 - Medicare Secondary Payment Where VA Authorizes Fewer Days Than Total Number of Covered Days in the Stay (Rev. 1, 10-01-03) A3-3153.1.C, HO-260.3.B The Medicare secondary payment is the lower of: • The gross amount payable by Medicare for all covered days in the stay (without regard to deductible or coinsurance) minus the amount paid by the VA for Medicare covered services, or • The gross amount payable by Medicare (without regard to deductible or coinsurance) minus any applicable Medicare deductible or coinsurance. EXAMPLE: The VA authorizes payment for 4 days of a 7-day stay. Charges for the 4 days total $2,350. The VA reimburses the hospital that amount. The gross amount payable by Medicare (unreduced by deductible and coinsurance) for the 7-day stay is $3,350. The beneficiary’s Part A deductible has not been met. The Medicare secondary payment is determined by subtracting the VA payment from the gross amount payable by Medicare: $3,350 - $2,350 = $1,000. Medicare pays $1,000, which is less than the gross amount payable by Medicare minus the Medicare deductible ($3,350 - $812 = $2,538). The beneficiary’s Part A deductible is met by the VA payment.