Revenue Cycle

Scenario: Billing diagnostic services on a swing bed claim

Medicare Update for CAHs, May 2, 2012

A patient was in a covered CAH swing bed stay receiving skilled nursing services for complications related to an acute myocardial infarction. During the swing bed stay, the patient began to complain of severe headaches. The physician ordered a CT of the brain without contrast followed by with contrast. After review of the exam, the findings were normal and no additional treatment or skilled services were required and the patient was discharged. Should the CAH bill the charges for the CT scan on the swing bed claim, TOB 181, or on a separate outpatient claim, TOB 851, because the procedure is listed as one of the major categories for SNF consolidated billing?

Since the CAH is reimbursed under the cost methodology, the CAH should bill the CT scan on the swing bed claim, TOB 181. Although the CT scan is considered a Major Category and is an “excluded” service under the SNF PPS consolidated billing requirements, CAHs are exempt from using the list and services provided while the patient is in a CAH’s swing bed should be included on the swing bed claim, regardless of the reason for the service, the findings, or if additional services were required. Patients in a covered Part A swing bed stay are not responsible for Part B coinsurance and deductible. <Social Security Act §§ 1888(e)(7), 1883(b)(3), 42 CFR 413.114, MLN Matters SE0606>

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