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(1) The remaining balance of the full PML after deducting the portion assigned to the first facility, or

(2) If there is no balance, zero PML.

2. A/B Has Medicare

The PML for Medicare beneficiaries is applied only to the month of admission to a hospital because the beneficiary is only responsible for the Medicare deductible amount. When LTC a/b has to enter a different medical facility, follow procedures below on assigning PML.

a. Hospital

(1) Admission date is on the first day of the month

(2) Assign full PML not to exceed the Medicare deductible amount.

b. Second facility

The amount of the "split" PML which is reported to the second facility following a Medicare hospital admission is:

(1) The remaining balance of the full PML for admission month minus the Medicare deductible amount.

(2) If hospital discharge month is different from admission month, assign the full PML to the second facility for discharge month.

c. If a Medicare a/b remains in the hospital for several months, the hospital will not collect the PML. However, the actual PML must be entered into NC FAST.

3. If the LTC a/b is within the 21-100 days for Medicare and is moved to a second nursing facility within the same month assign number of days in the first facility times the Medicare co-payment rate to the first facility. Do not include the discharge date. This is the actual amount for which the beneficiary is responsible. Report the remaining balance of the PML to the second facility. Reminder: Medicare may not pay the first 100 days in every situation. Contact the facility to verify this information.

4. If a third or more facility is involved, repeat the process in IX.D.1.c. or 2.b., above, according to whether the a/b has Medicare until the PML is exhausted.

5. Do not round or drop cents.

6. Any remaining PML not collected will accumulate in the beneficiary’s personal funds as reserve the following month.

Flag case to check reserve monthly when the client is in danger of exceeding the reserve allowance.

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493

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Official source

(1) The remaining balance of the full PML after deducting the portion assigned to the first facility, or

(2) If there is no balance, zero PML.

2. A/B Has Medicare

a. Hospital

(1) Admission date is on the first day of the month

(2) Assign full PML not to exceed the Medicare deductible amount.

b. Second facility

The amount of the "split" PML which is reported to the second facility following a Medicare hospital admission is:

(1) The remaining balance of the full PML for admission month minus the Medicare deductible amount.

(2) If hospital discharge month is different from admission month, assign the full PML to the second facility for discharge month.

c. If a Medicare a/b remains in the hospital for several months, the hospital will not collect the PML. However, the actual PML must be entered into NC FAST.

4. If a third or more facility is involved, repeat the process in IX.D.1.c. or 2.b., above, according to whether the a/b has Medicare until the PML is exhausted.

5. Do not round or drop cents.

6. Any remaining PML not collected will accumulate in the beneficiary’s personal funds as reserve the following month.

Flag case to check reserve monthly when the client is in danger of exceeding the reserve allowance.

Docusign Envelope ID: 950E9248-29CC-8930-81BC-BCEC667EB493