WakeMed Reinterates Their Position Without
Clarifying Key Questions
January 08, 2014
From: "PATREKA WORTHAM"
To: Fred Lempe
Cc: Monique Utley, "STACIE ILKHANIZADEH", "CONNIE WITHAM"
Sent: Wednesday, January 8, 2014 2:22:06 PM
Subject: FW: Medicare Lifetime Reserve Day letter MR# 1948092
As a follow-up to our discussion today, please see detailed responses to your previous questions
1. I need to know what you meant by being held responsible by WakeMed if I choose the wrong
choice with Freddie’s LTR days.
A: If the family elects NOT to use LTRD’s, Medicaid will not be available for to be billed for
these day also.
2. Was WakeMed taking this same position before Freddie’s NC Medicare was added an
A: LTRD’s did not apply until Medicare was filed for this case. Additionally, please know that
it is to your benefit to use these days now as it then allows the opportunity for Medicaid to
also be used as an additional payer for the balance. Medicaid will not pay unless it is the
payer of “last resort”. (i.e. The LTRD’s must be exhausted first.)
3. If WakeMed takes Freddie’s LTR days, wouldn’t they too run out after 60 days and what would
WakeMed’s position be then?
A: If the LTR days run out, Medicaid can be billed for the non-covered days after exhaustion
4. What date does this have to be resolved by to ensure that Freddie’s LTR days will be
protected from WakeMed?
A: Medicare requires that we notify you “when the beneficiary has five regular coinsurance
days left and is expected to be hospitalized beyond that period”. This timeline has been
reached. Further, an election not to use lifetime reserve days “may be made at the time of
admission to a hospital or at any time thereafter...” If the option not to use LTRD’s is selected
now, additional Medicaid benefits for this account noted in #2 above would not apply and
you would be responsible for the balance.
5. Does me telling you in the emails suffice as notice to WakeMed not to use Freddie’s LTR
A: Case Management will have patient’s family complete form indicating non-use of LTR
days. (Case Mgmt Form: LRD NO REGULAR DAYS)
6. Is filling out, signing and delivery of the letter form that you sent attached to your email,
what it takes to finalize the decision of Freddie’s LTR days? The form seems to just be a
notice and doesn’t have a place for any declaration of LTR days to be used or not used.
A: Deferred to Case Management. Mr. Lempe appears to have only received notification.
(Case Mgmt Form: LRD OTHER SECONDARY INS) Form per #5 above references not utilizing
LTRDs. Connie - Please advise.
7. Why is the form that you sent for me to sign left blank? I have been advised not to sign
unfilled, blank forms. The letter form states that it is to be filled out by WakeMed’s staff and
has not been.
A: Deferred to Case Management. Connie - Please advise.
Additional guidance from CMS:
30 - Election Not to Use Lifetime Reserve Days
(Rev. 1, 10-01-03)
30.1 - General
(Rev. 1, 10-01-03)
An election not to use lifetime reserve days may be made by the beneficiary (or by someone acting
on his or her behalf) at the time of admission to a hospital or at any time thereafter, subject to the
limitations on retroactive elections described in §30.3 below.
Hospitals are required to notify patients who have already used or will use 90 days of benefits in a
benefit period that they can elect not to use their reserve days for all or part of a stay. The hospital
notice should be given when the beneficiary has five regular coinsurance days left and is expected to
be hospitalized beyond that period. Where the hospital discovers the patient has fewer than five
regular coinsurance days left, it should immediately notify the patient of this option. The hospital
should annotate its records at the time that it informed the patient of this option. In addition, it
should make available an appropriate election statement or form to be included in the patient's
hospital record if the patient elects not to use reserve days. (See §40.1 for sample election format).
If a patient elects not to use reserve days, covered Part B services are billed on Form CMS-1450 or the
electronic equivalent to the intermediary. A Medicare beneficiary who is eligible for medical
assistance (Medicaid) under a State plan should be advised that
such assistance would not be available if the beneficiary elects not to use the lifetime reserve days.
However, this restriction on medical assistance payments does not apply to cases where the beneficiary
is deemed to have elected not to use lifetime reserve days.