Part A SNF PPS for Hospital Swing Bed Facilities

100 - Part A SNF PPS for Hospital Swing Bed Facilities (Rev. 1, 10-01-03) PM A-02-016 Section 4432(a) of the Balanced Budget Act (BBA) of 1997 specifies that swing bed facilities must be incorporated into Part A SNF PPS by the end of the statutory transition period. Effective with cost reporting periods beginning on or after July 1, 2002, swing bed bills are not paid on the cost-based method, but rather on the basis of the Part A SNF PPS. These payment rates cover all payment for furnishing covered swing bed extended care services (routine, ancillary, and capital-related costs) other than approved educational activities as defined in 42 CFR 413.85. Part A SNF PPS applies to short-term hospitals, long-term care hospitals, and rehabilitation hospitals that have Medicare swing bed agreements. CAHs with swing beds are exempt from the Part A SNF PPS, and are not affected by these instructions. The Part A PPS is phased in based on each swing bed hospital’s fiscal year. The transition to Part A PPS is effective with the start of the provider’s first cost reporting period that begins on or after July 1, 2002. Consequently, billing for all beneficiaries in a swing bed must be split at the end of the provider’s fiscal year. A new bill is created for beneficiaries remaining in the facility at the start of the new fiscal year. The bill must be prepared under the Part A PPS claim guidelines described in this chapter and in Chapter 1, “General Billing Requirements.” Payment is made according to the instructions for SNFs under Part A PPS found in the Medicare Provider Reimbursement Manual. Providers of swing bed services submit Part A inpatient claims using TOB 18X. The swing bed program does not include an inpatient Part B benefit. For beneficiaries who continue to receive extended care services after the end of a Part A stay (e.g., benefits exhausted, not receiving a skilled level of care, etc.), ancillary services may be billed under the hospital as inpatient Part B services. If the beneficiary remains a resident in the swing bed facility after the end of the Part A stay, the hospital may submit a claim to the A/B MAC (A) for those inpatient services covered by Part B using TOB 12X. The beneficiary would be eligible for the same benefits available to a hospital inpatient in a Part B stay. The hospital provider of SNF level swing bed services must also file a Part A nonpayment bill monthly using the appropriate nonpayment code. For Part A PPS purposes, A/B MACs (A) assign swing bed hospitals to provider type 38 on their Provider-Specific File. Swing bed providers will be paid at 100 percent of the Federal rate. Swing bed claims will be paid using the actual MSA code (based on county codes), and the related rural or urban rate tables. A/B MACs (A) must set the Federal PPS Blend Indicator in the Provider-Specific file to “4.” The CMI ADJ CPD field should be blank. Unless exceptions are noted, instructions applicable to SNFs are also applicable to swing bed providers e.g., demand bills, spell of illness, covered and noncovered days, nonpayment bills, and adjustment bills.