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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.