1 / 9

Swing Beds

Lesson 3 Medicaid Services. Swing Beds. Medicaid Coverage. Georgia Medicaid will cover swing-bed services for recipients who require a nursing facility level of care on a DAILY basis. A physician must certify that the nursing facility care is needed.

aloha
Télécharger la présentation

Swing Beds

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lesson 3 Medicaid Services Swing Beds

  2. Medicaid Coverage • Georgia Medicaid will cover swing-bed services for recipients who require a nursing facility level of care on a DAILY basis. • A physician must certify that the nursing facility care is needed. • The certification must be obtained at the time of admission to the swing-bed, or on the next working day if admitted on a weekend or holiday.

  3. Medicaid Coverage • Changes in recipient status (discharge, termination etc.) must be reported to the Department of Family Services office on a Form DMA-59.

  4. Medicaid Reimbursement • The Medicaid reimbursement rate is all-inclusive and covers: • Room and Board • Laundry • Nursing and routine services • All nursing services (excluding private duty nurses) • Most ancillary services

  5. Limits to Swing-Bed Coverage • If the hospital has more than 49 beds but less than 100 beds, it cannot keep a Medicaid patient in a swing-bed for more than five days beyond the later of: • Any date on which a bed is available for the patient in a nursing facility (NF) located within the hospital geographic region • The date that a hospital learns that a (NF) bed is available, or • The date the facility is notified that a (NF) bed will become available.

  6. Limits to Swing-Bed Coverage • These swing-bed facilities must transfer swing-bed patients within five (5) days (excluding holidays and weekends) for an available SNF bed in the geographic region unless • Physician certifies the transfer is not medically appropriate. • Hospitals with less than 50 beds are not required to transfer.

  7. Medicare / Medicaid • If a patient is covered under Medicare and Medicaid, the swing-bed facility must bill Medicare prior to billing Medicaid. • Medicare will reimburse for the first twenty days at 100% of the Medicare rate.

  8. Medicaid Coinsurance • For the 21st to 100th day of skilled coverage, Medicare will pay a reduced amount and Medicaid will pay the applicable coinsurance amount. • 1/8 of inpatient patient deductible • The Medicaid coinsurance amount cannot exceed the Medicaid allowed amount.

  9. Medicaid Coinsurance • Before Medicaid will pay coinsurance, the hospital must have • Approved/paid Medicare Remittance Advice and • A UB-04 Claim form. To obtain detailed specifics, please refer to the Billing Manual and the Category of Service specific policy manuals posted on the GHP Web Portal at www.ghp.georgia.gov.

More Related