Swing bed coding

[snjberry]

Can someone help by telling me if you can bill for professional svcs during SNF swing stay. I have never billed swing and my inpt billers are telling me that MD's are covered in total swing stay. Is that true? Thanks

 

[KellyLR]

Swing Bed Coding Resources from CMS

Seems like you would like to have the reg and guidelines on this. I've been studying up on this myself today. Try these links:
www.cms.gov/SNFPPS/03_SwingBed.asp
www.cms.gov/SNFPPS/01_overview.asp
www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

For critical care:
www.cms.gov/MLNProducts/downloads/SwingBedFactsheet.pdf

Hospitals:
www.cms.gov/SNFPPS/Downloads/SB_dataspecs.pdf

Cost Allocation
www.cms.gov/Transmittals/downloads/A0109.pdf

Reg Rules:
CMS-1410-P 2010

CMS-1410-CN 2010

CMS-1410-F 2010 ("F" I think means "Final Rule")

Maybe this will give you some better understanding. Hopefully, someone here will have a quick and defenitive answer that will help you right away, I am just learning more in depth about swing bed and SNF facilities myself and I just happened to be in the CMS site and by coincdence came in here to see if anyone could answer a question I have by researching this forum when I came across your post. I don't feel comfortable blabbing about what little I know but am happy to share CMS links.

But here is an excerpt from CMS about swing bed uses, etc. straight from CMS:

The Social Security Act (the Act) permits certain small, rural hospitals to enter into a swing bed agreement, under which the hospital can use its beds, as needed, to provide either acute or SNF care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Medicare Part A (the hospital insurance program) covers post-hospital extended care services furnished in a swing bed hospital.

Under the Balanced Budget Act (BBA) of 1997, swing bed facilities must be incorporated into the skilled nursing facility (SNF) prospective payment system (PPS) by the end of a statutory transition period. This applies to short term hospitals, long term hospitals, and rehabilitation hospitals certified as swing bed hospitals. CAHs with swing beds are exempt from the SNF PPS under more recent legislation. To qualify for SNF-level services, a beneficiary is required to receive acute care as a hospital inpatient for a medically necessary stay of at least 3 consecutive calendar days. Effective with cost reporting periods beginning on or after July 1, 2002, swing bed hospitals will no longer be paid based on the current cost-related method, but rather on the basis of the SNF PPS.

The SNF PPS covers all costs (ancillary, routine, and capital) related to covered services furnished to beneficiaries under Medicare Part A. Like the PPS for inpatient hospital services, the SNF PPS excludes certain specified services, which are separately billable to Part B. The PPS relies on information from a resident assessment instrument to classify residents into one of 44 categories for payment purposes. Swing bed hospitals will be required to use a special two-page assessment form to meet this requirement.

Good luck!

 

[KellyLR]

Swing Bed Coding Resources from CMS

Seems like you would like to have the reg and guidelines on this. I've been studying up on this myself today. Try these links:
www.cms.gov/SNFPPS/03_SwingBed.asp
www.cms.gov/SNFPPS/01_overview.asp
www.cms.gov/NursingHomeQualityInits/25_NHQIMDS30.asp

For critical care:
www.cms.gov/MLNProducts/downloads/SwingBedFactsheet.pdf

Hospitals:
www.cms.gov/SNFPPS/Downloads/SB_dataspecs.pdf

Cost Allocation
www.cms.gov/Transmittals/downloads/A0109.pdf

Reg Rules:
CMS-1410-P 2010

CMS-1410-CN 2010

CMS-1410-F 2010 ("F" I think means "Final Rule")

Maybe this will give you some better understanding. Hopefully, someone here will have a quick and defenitive answer that will help you right away, I am just learning more in depth about swing bed and SNF facilities myself and I just happened to be in the CMS site and by coincdence came in here to see if anyone could answer a question I have by researching this forum when I came across your post. I don't feel comfortable blabbing about what little I know but am happy to share CMS links.

But here is an excerpt from CMS about swing bed uses, etc. straight from CMS:

The Social Security Act (the Act) permits certain small, rural hospitals to enter into a swing bed agreement, under which the hospital can use its beds, as needed, to provide either acute or SNF care. As defined in the regulations, a swing bed hospital is a hospital or critical access hospital (CAH) participating in Medicare that has CMS approval to provide post-hospital SNF care and meets certain requirements. Medicare Part A (the hospital insurance program) covers post-hospital extended care services furnished in a swing bed hospital.

Under the Balanced Budget Act (BBA) of 1997, swing bed facilities must be incorporated into the skilled nursing facility (SNF) prospective payment system (PPS) by the end of a statutory transition period. This applies to short term hospitals, long term hospitals, and rehabilitation hospitals certified as swing bed hospitals. CAHs with swing beds are exempt from the SNF PPS under more recent legislation. To qualify for SNF-level services, a beneficiary is required to receive acute care as a hospital inpatient for a medically necessary stay of at least 3 consecutive calendar days. Effective with cost reporting periods beginning on or after July 1, 2002, swing bed hospitals will no longer be paid based on the current cost-related method, but rather on the basis of the SNF PPS.

The SNF PPS covers all costs (ancillary, routine, and capital) related to covered services furnished to beneficiaries under Medicare Part A. Like the PPS for inpatient hospital services, the SNF PPS excludes certain specified services, which are separately billable to Part B. The PPS relies on information from a resident assessment instrument to classify residents into one of 44 categories for payment purposes. Swing bed hospitals will be required to use a special two-page assessment form to meet this requirement.

There is a manual on the CMS site under Swing Bed Providers that discusses MD's coverage.

Good luck!