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Swing Beds. Lesson 2 Medicare Services. Swing-Bed. Must be granted approval by CMS Allows beds for either acute or post-acute care No special section required Differs in reimbursement from acute care
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Swing Beds Lesson 2 Medicare Services
Swing-Bed • Must be granted approval by CMS • Allows beds for either acute or post-acute care • No special section required • Differs in reimbursement from acute care • Change in status can occur within one facility OR patient can be transferred from another facility
Swing-Bed • Must have separate swing-bed section in medical chart • No LOS restriction • Requires prior 3-day qualifying stay in hospital or Critical Access Hospital (CAH) to receive Medicare reimbursement • Must fall within same spell of illness
Swing-Bed Claims • Maximum number of covered Part A SNF days in a benefit period is 100. • CMS 1450 claims are submitted to the Fiscal Intermediary. • Part A claims must be submitted in sequential order per admission date. • HCPCS are not required on Part A swing-bed claims for ancillary services.
Swing-Bed Claims • When a beneficiary is no longer covered by Part A benefits, inpatient hospital Part B claims may be submitted to the FI for ancillary services covered by Part B. • The beneficiary will remain in a swing-bed unless discharged, transferred to another SNF or requires a transfer back to the hospital at an ACUTE level of care.
Types of Reimbursement • Acute Care Hospital • Medicare reimbursement for swing-beds is based upon a Prospective Payment System • Critical Access Hospital • Medicare reimbursement for swing-beds is based upon a Cost Based System
Acute Care Hospital Medicare Swing Bed Services
SNF PPS • Acute Care (Non-CAH) Swing-bed facilities are paid under the Part A SNF PPS rules. • SNF PPS requires the performance of periodic Swing-Bed MDS assessments. • SNF PPS payment rates cover routine, ancillary and capital-related costs.
SNF PPS • These two components from the MDS forms are used to determine the RUG (resource utilization group) for the patient stay. • RUG categories determine the Medicare payment rates for the PPS swing-beds.
SNF PPS • Providers of swing-bed SNF PPS services file inpatient claims using Type of Bill 18X. • If a beneficiary remains in the swing-bed after the end of a Part A stay, inpatient services covered under Part B may be billed with a Type of Bill 12X.
SNF PPS • Consolidated billing rules apply to SNF PPS Part A services. • All services not specifically excluded from SNF PPS consolidated billing requirements must be included in the swing-bed bill (TOB 18X).
SNF PPS • Swing-bed hospitals may separately bill any covered services excluded under the SNF PPS consolidated billing provisions. • These services must be billed by the swing bed hospital using the hospital provider number.
Critical Access Hospital Medicare Swing Bed Services
Eligibility – CAH Bed Size • A CAH may use its inpatient facilities to provide post-hospital SNF care and be paid for SNF-level of services if it meets the following requirements: • The facility has been certified as a CAH by CMS; • The facility can operate up to 25 beds for either acute (CAH) care or SNF swing-bed care • The facility has been granted swing-bed approval by CMS.
Critical Access Hospital Billing • Under BIPA (Benefits Improvement and Protection Act of 2000) • Swing beds in Critical Access Hospitals are exempt from SNF Prospective Payment Reimbursement • CAHs receive full reasonable cost reimbursement plus 1%. • 42 U.S.C. §1395tt1883(a)(3) Notwithstanding any other provision of this title, a critical access hospital shall be paid for covered skilled nursing facility services furnished under an agreement entered into under this section on the basis of equal to 101 percent of the reasonable costs of such services (as determined under section 1861(v)).
CAH Swing-Bed • Completion of MDS not required. • Although swing-bed patients receive SNF level of care, they are NOT SNF patients – considered patients of the CAH.
CAH Swing-Bed • Paid at 101% of reasonable cost. • SNF Consolidated Billing rules do not apply to a CAH swing bed provider. • All CAH swing-bed SNF level care bills are submitted and processed with a “Z” in the third position of the provider number. Medicare Claims Proc Manual Chap 3, Section 30.1.2
Comparison MEDICARE SWING BED