Under what condition does a new spell of illness for Medicare Part A begin?

A new spell of illness for Medicare Part A begins when a patient has been discharged from a prior stay in a hospital or skilled nursing facility, followed by a lapse of 60 days. This framework is important because it helps define how Medicare handles successive hospitalizations and helps ensure that the patient receives appropriate coverage for ongoing medical needs without interruptions.

Specifically, after a patient is discharged, if they experience a new illness or exacerbation of an existing condition requiring hospitalization and at least 60 days have passed since their last discharge, Medicare recognizes this as a new spell of illness. This rule is in place to prevent continuous coverage for related conditions that may not necessitate a new hospitalization, and it also helps manage resource utilization effectively.

Understanding this specific timeframe assists healthcare providers in navigating Medicare billing and coverage options accurately, ensuring both patient care and compliance with Medicare regulations.