Quick Explanation
Denial code CO-67 indicates that a Medicare beneficiary has exhausted their 60 lifetime reserve days for inpatient hospital stays under Medicare Part A. Once these additional days are fully utilized beyond the standard 90-day benefit period, Medicare will no longer cover the inpatient room and board charges. Providers must identify alternative coverage sources, verify if a new benefit period has begun, or bill the patient if proper notice was provided.
Common Causes for CO-67
Denials with code CO-67 typically happen for the following specific reasons:
- The patient had prior prolonged inpatient hospitalizations that completely utilized the 60 lifetime reserve days under Medicare Part A.
- Failure to verify the patient's remaining Medicare benefit days via the HIPAA Eligibility Transaction System (HETS) prior to or during a long-term admission.
- Incorrect calculation of the 60-day wellness period required to reset a Medicare benefit period, leading to premature billing of Part A.
- The patient elected not to use their remaining lifetime reserve days, but the claim was mistakenly submitted to Medicare Part A without the appropriate Condition Code to preserve them.
How to Prevent CO-67 Denials
To avoid receiving this denial in the future, implement these specific checks:
- Verify the patient's Medicare inpatient benefit days through HETS or the Common Working File (CWF) at the time of admission and weekly during extended stays.
- Utilize Medicare Condition Code 9 (Patient elects not to use lifetime reserve days) when applicable to preserve remaining days for future use.
- Secure a signed Advance Beneficiary Notice of Noncoverage (ABN) or hospital notice of non-coverage once benefits are nearing exhaustion to establish patient financial responsibility.
- Identify and bill secondary commercial or Medigap payers promptly, as these supplemental plans frequently cover an additional 365 lifetime inpatient days after Medicare benefits are exhausted.
Appeal Letter Template for CO-67
If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.
[Your Practice Header]
[Date]
[Payer Name]
[Appeals Department Address]
RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: CO-67 - Lifetime reserve days have been exhausted
Dear Appeals Department,
I am writing to appeal the denial of the above-referenced claim, which was denied with code CO-67: "Lifetime reserve days have been exhausted".
We are writing to appeal the denial of coverage under code CO-67 for the inpatient services rendered. While we acknowledge that the patient's Medicare Part A lifetime reserve days have been exhausted for this benefit period, we request payment consideration under CMS guidelines for Medicare Part B inpatient ancillary services. Pursuant to the Medicare Benefit Policy Manual (CMS Pub. 100-02, Chapter 6, Section 10), when Part A benefits are exhausted, certain ancillary services (such as laboratory, radiology, and therapy services) remain billable and payable under Medicare Part B. Additionally, if applicable, we have attached the secondary payer information, as supplemental Medigap policies are required to provide coverage for up to 365 additional lifetime reserve days. We request that this claim be adjusted to reflect Part B ancillary coverage or forwarded to the secondary payer for immediate processing.
Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].
We respectfully request that you reprocess this claim for payment.
Sincerely,
[Your Name]
[Title]
[Practice Name]
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