CAH Swing Bed Billing Guide - JF Part A
Critical Access Hospital Swing Bed Billing Guide
Requirement | Description |
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Unique Identifying Provider Number Ranges | 3rd - 6th digits:
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Bill Type |
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Billable Visit/Services CMS Internet Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section10.2 |
Skilled level of care in approved CAH hospital certified swing-bed. Subject to hospital bundling requirements. Nonprofessional services and applicable Certified Registered Nurse Anesthetist (CRNA) service must be included on CAH’s swing-bed bill. A swing bed is not considered hospital level care. It is defined in the payment regulations as SNF level care and is reimbursed at a lesser amount. Must have a discharge summary following acute care services. When discharged from the swing bed a discharge summary of skilled nursing level services is required. |
Payment Type CMS, IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 30.1.2 |
Skilled nursing level services are paid at 101% of reasonable cost. |
Frequency of Billing CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 50.2-50.2.3 |
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Benefit Period - Billing for Days CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 40.3.5 CMS IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 3, Section 20 |
Annual Benefits
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Swing Bed Days - Cost Reporting | In accordance with PRM-II, 3605.1 M+C (Medicare + Choice, Medicare Advantage, Medicare HMO) swing bed days should be excluded from Worksheet S-3, Part I, Line 3, Column 4 and only reported on Worksheet S-3, Part I, Line 3, Column 6. Only Medicare fee-for-service swing bed days should be reported on Worksheet S-3, Part I, Line 3, Column 4. |
Revenue Codes Refer to National Uniform Billing Committee NUBC |
Not an all-inclusive list
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Condition Codes CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 200.2 Transmittal 1290, Change Request 5653 CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 150.3.3 |
Payer codes if applicable
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Interrupted Stays/LOA | Three-day interrupted stay policy is defined as "a greater than 3-day interruption of stay". When the hospital discharges and beneficiary returns by midnight on the third consecutive day; bill days in non-covered, use 74 occurrence span code and date. |
Benefit Exhaust CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 40.8 |
First claim usually partial benefits exhaust claim then next month total benefits exhaust.
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Occurrence Codes and Date CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 80.3.2.2 |
Payer codes if applicable
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Occurrence Span Codes and Date CMS, IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 6 Section 30 and 40 |
Three-day hospital stays required on claims for coverage and Medicare payment
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Value Codes | Codes and related dollar amount that are necessity to process claims
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Ancillary Services CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 240 |
Medicare pays Part B inpatient services when beneficiary is not entitled to benefits under Part A, benefits exhaust, or stay not medically necessary
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Medicare Advantage (MA) CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 6, Section 90 |
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Beneficiary Coinsurance | Annual Benefits |
Beneficiary Deductible | Annual Benefits |
Last Updated Fri, 08 Sep 2023 17:09:50 +0000