Effect on Utilization Days and Benefit Period

50.1 - Effect on Utilization Days and Benefit Period (Rev. 1555; Issued: 07-18-08; Effective Date: 01-01-09; Implementation Date: 01- 05-09) Payment sanctions are applied to days that would otherwise be Part A-payable; i.e., the care is covered but no payment will be made to the provider. Therefore, if the Medicare participating SNF assumes responsibility for the beneficiary’s costs during the sanction period, it will be considered the same as a program payment, and the days will count towards the 100-day benefit period. In situations where the beneficiary is subject to the payment ban, but the provider fails to issue the proper beneficiary liability notice, the provider is liable for all services normally covered under the Medicare Part A benefit. Since the beneficiary is receiving benefits, the days will be considered Part A days and charged against the beneficiary’s benefit period. The SNF may collect any applicable copayment amounts. These days will be charged against the beneficiary’s utilization as is currently done with other types of technical denials (i.e., late filing, late denial notices to the patient, etc.). If the SNF issues the appropriate beneficiary liability notice, and the beneficiary agrees to make payment either personally or through a private insurer, the days will not be charged towards the 100-day benefit period.