Inpatient
The "Inpatient" sub-tab includes Inpatient, Skilled Nursing Facility (SNF), and Psychiatric Benefit Data sections. The Inpatient section provides hospital inpatient benefit and billing information. The SNF section provides SNF benefit and billing information.
NOTE: While the Psychiatric Benefit Data section now displays in myCGS, the data is not yet available in CMS' HIPAA Eligibility Transaction System (HETS) 270/271 system that we are required to access for eligibility.
The system will return hospital inpatient default deductibles based on the requested start year when the following occurs:
- No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date (range)
- Entitlement period and request date period overlap
- Part A entitlement start year is less than the requested start year
In addition, the system will continue to return the hospital inpatient default deductible remaining amounts, inpatient co-payment days, and SNF co-payment days based on the beneficiary's Part A entitlement start year when the following occurs:
- No inpatient spell data returned from the database overlaps or falls within 60 days of the requested date (range)
- Entitlement period and request date period overlap
- Part A entitlement start year is less than or equal to the requested start year
NOTE: Depending on the date(s) range requested, multiple inpatient and SNF spells might be displayed. The data returned on this screen is directly impacted by timely submission of claims by the provider. The data returned is compiled from claims that have been processed by the Common Working File (CWF). To make sure you see all the information, enter a date range in the inquiry screen.
If a single hospital inpatient/SNF spell spans more than one calendar year, myCGS will return the daily co-payment amounts associated with the beginning year of the spell.
If there is no hospital inpatient/SNF spell within 60 days of the requested date(s) of service, myCGS will return default values for Part A spell data.
The table below describes the "Inpatient" sub-tab fields:
Part A Deductible
Field Name | Description |
---|---|
Start/End Date |
The beginning and end date for the calendar year requested. |
Deductible Amount |
The Medicare Part A deductible amount applied to each spell of illness that occurs during the calendar year. |
Inpatient Spell of Illness Detail
Field Name | Description |
---|---|
Start Date (DOEBA) |
The date of earliest billing activity for the spell of illness |
End Date (DOLBA) |
The date of latest billing activity for the spell of illness |
Billing NPI |
The billing NPI of the hospital and/or SNF. You may refer to the NPPES NPI Registry |
Type |
Displays the type of provider identified in the Billing NPI field |
Days Allowed
Identifies the number full and co-insurance days allowed for hospital, skilled nursing facility (SNF), Lifetime Reserve, and Lifetime Inpatient Psychiatric Hospital based upon the calendar year requested. The co-insurance amounts are displayed for each, as well.
Days Remaining
Field Name | Description |
---|---|
DOEBA |
The date of earliest billing activity for the spell of illness |
DOLBA |
The date of latest billing activity for the spell of illness |
Full Days |
The number of inpatient full days allowed for the calendar year requested |
Co-insurance Days |
The number of inpatient full co-insurance days allowed for the calendar year requested |
Billing NPI |
The billing NPI of the hospital and/or SNF. You may refer to the NPPES NPI Registry to find the facility’s contact information. |
Part A Free Services
Field Name | Description |
---|---|
STC Codes |
The Health Care Service Type Codes (STC) identify classifications of services or benefits. For definitions of the two-digit codes, view the link for "List of STC Codes." |
Value |
The patient's portion of responsibility for a benefit, represented as a percentage |
Start/End Date |
The start and end dates of the benefit period |