Revenue Cycle

True or false quiz: Billing for CT scan during a swing bed stay

Medicare Update for CAHs, October 31, 2012

Scenario: George, a Medicare patient, was in a covered swing bed stay receiving skilled nursing for compliances related to a heart attack. During the stay, George began to complain of severe headaches, so the physician ordered a CT of the brain with and without contrast. After reviewing the exam, the findings were normal and no additional treatment or skilled services were required, so George was discharged and free to go home. The CAH will bill the charges for the CT scan on an outpatient claim because the procedure is listed as one of the major categories for SNF consolidating billing.

True or false?

 
 
 
 
 
 
 
 
 

False.  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. <Social Security Act

§§ 1888(e)(7), 1883(b)(3), 42 CFR 413.114, MLN Matters SE0606>

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