Effect of Reserve Days on Guarantee of Payment Provision

10.1 - Effect of Reserve Days on Guarantee of Payment Provision (Rev. 1, 10-01-03) A3-3106.B, HO-219.B, A3-3714 The guarantee of payment provisions extend to inpatient services furnished to individuals who have exhausted their eligibility for inpatient hospital services and does not extend to individuals who have no coverage for other reasons, e.g., one who is not entitled under hospital insurance or whose entitlement has been terminated. Under the guarantee of payment provisions a hospital may be paid, under certain conditions, for inpatient services furnished to a beneficiary whose eligibility for inpatient benefit days has been exhausted, including exhaustion of the 190-day lifetime limitation on inpatient psychiatric hospital services. The guarantee of payment provisions are not applicable until the individual has exhausted 60 lifetime reserve days of inpatient hospital services except where the beneficiary is deemed to have elected not to use lifetime reserve days. (See §10.2, below, and see §30, below.) See the Medicare Claim Processing Manual, Chapter 2 for instructions relating to guarantee of payment.