Types of Facilities Subject to the Consolidated Billing

10.2 - Types of Facilities Subject to the Consolidated Billing Requirement for SNFs (Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11- 05-19) Consolidated billing applies to: • Participating SNFs; • Short term hospitals, long term hospitals, and rehabilitation hospitals certified as swing-bed hospitals, except critical access hospitals (CAHs) certified as swing bed hospitals (however, while a CAH’s SNF-level swing bed services are not subject to consolidated billing, they remain subject to the bundling requirement for hospitals, as specified in the Medicare Claims Processing Manual, Chapter 3, §60). Rural (non-CAH) swing bed hospitals that furnish SNF-level services are subject to both the consolidated billing and hospital bundling requirements (see §100.1); accordingly, as explained in the FY 2002 SNF PPS final rule (66 FR 39593, July 31, 2001), for the small number of services (such as dialysis) that are excluded from consolidated billing but remain subject to hospital bundling, the billing responsibility would remain with the rural swing bed hospital itself (in accordance with the hospital bundling requirement), but it would use a separate inpatient Part B claim to bill for those services outside of the bundled SNF PPS rate (in recognition of their exclusion from the consolidated billing requirement). But consolidated billing does not apply to: • A nursing home that is not Medicare-certified, such as: o A nursing home that does not participate at all in either the Medicare or Medicaid programs; o A non-certified part of a nursing home that also includes a participating distinct part SNF unit; and o A nursing home that exclusively participates in the Medicaid program as an NF. • CAHs certified as swing-bed hospitals. However, as noted above, CAH swing- bed services are subject to the hospital bundling requirement at section 1862(a)(14) of the Social Security Act and 42 CFR § 411.15(m). Medicare Coordinated Care Demonstration Services for beneficiaries covered under the Medicare Coordinated Care Demonstration will not be subject to consolidated billing. Common Working File (CWF) will appropriately edit for these codes so that the A/B MACs (B) will pay them separately.