Retroactive Election

30.3 - Retroactive Election (Rev. 1, 10-01-03) A3-3106.2.C, HO-219.2.C A beneficiary may retroactively elect not to use reserve days provided when: • The beneficiary (or some other source) offers to pay the hospital for any of the services not payable under Part B; and • The hospital agrees to accept the retroactive election. In this case, the hospital will contact the A/B MAC (A) for procedures for correcting any claims already submitted. A retroactive election not to use the lifetime reserve days must be filed within 90 days following the beneficiary's discharge from the hospital unless benefits are available from a third party payer to pay for the services and the hospital agrees to the retroactive election. In that case, the beneficiary may file an election not to use the lifetime reserve days later than 90 days following discharge. EXAMPLE 1: Prior to July 1, Mr. Jones had used 90 days of inpatient hospital services in a benefit period. Beginning July 1, he was hospitalized for 10 additional days in that same benefit period. He was informed of his election right on July 1 at the time of admission and indicated that he wanted to use his reserve days for that stay. One month after being discharged from the hospital, Mr. Jones informed the hospital's billing office that he now wished to save his reserve days for a future stay. Mr. Jones agreed to pay the hospital for the services he received during the 10 days of hospitalization, which were not payable under Part B, and was permitted to file a retroactive election not to use his reserve days, effective July 1. EXAMPLE 2: On July 1, Mrs. Smith was discharged from a hospital after being hospitalized for 105 days. The hospital billed Medicare for 90 regular days plus 15 lifetime reserve days. On October 20 (more than 90 days following discharge), Mrs. Smith learned that a private insurer could pay for the last 15 days of the stay. She informed the hospital that she wished to file a retroactive election not to use lifetime reserve days for the last 15 days of the stay. The hospital agreed to the request, and Mrs. Smith filed an election form. The hospital refunded the Medicare payment and billed the private insurer instead.