Swing-Bed Services

Swing-bed services must be billed separately from inpatient hospital services. Swing-bed hospitals use one provider number when billing for hospital services to identify hospital swing-bed SNF bills. The following alpha letters identify hospital swing-bed SNF bills (for CMS use only, effective May 23, 2007, providers are required to submit only their NPI. NOTE: The swing-bed NPI will be mapped to the 6-digit alpha-numeric legacy (OSCAR) number.):

"U" = short-term/acute care hospital swing-bed;

 "W" = long-term hospital swing-bed;

 "Y" = rehabilitation hospital swing-bed; and

 ”Z”=CAH swing-bed.

A. - Inpatient Hospital Services in a Swing-Bed

The patient status code of 03 is inserted on the claim when the beneficiary swings from acute to SNF level of care. (This constitutes a discharge for purposes of Medicare payment for inpatient hospital services under PPS.) The A/B MAC (A) indicates in the Statement Covers Through Date the last day of care at the hospital level.

If the beneficiary is discharged from a Medicare swing bed and remains in the hospital, there is no need for a no-pay bill. However, if a beneficiary continues to receive care after completing their stay in a SNF swing bed, in a NF swing bed, the hospital must submit covered claims to Medicare.

B. - SNF Services in a Swing-Bed

• The date of admission on the swing-bed SNF bill is the date the patient began to receive SNF level of care services;

• State level agreements may call for varying types of bill coding Type of Bill. The CMS does not perform edits on type of bill coding on bills with 8 in the 2nd digit (bill classification), in FL 18 of the CWF inpatient record if the record is identified in FL 1 as hospital or SNF. Therefore, the A/B MAC (A) accepts, with subsequent conversion, any bill type agreed to at the State level to identify swing-bed billing, i.e., 18X or 21X. It must be sure the record identification of CWF FL 1 is consistent with the provider number shown.

Providers Using All-Inclusive Rates for Inpatient Part A Charges

Some providers have been approved to bill a flat fee charge for inpatient services based on either a daily basis or total stay basis for services furnished. This is an "All-Inclusive Rate." These charges may cover room and board, including ancillary services, or room and board only. These instructions explain the essential data entries that must be made using the ASC X12 837 institutional claim format or on the Form CMS-1450 by providers that use all-inclusive rates as charges. All-inclusive rate providers are identified by one of the following charge structures:

• One total all-inclusive charge rate for both accommodations and ancillary services, including the cost of blood in the rate; 

• One total all-inclusive charge rate for both accommodations and ancillary services, not including the cost of blood in the rate; 

• One all-inclusive charge rate for accommodations and another for ancillary services, including the cost of blood in the all-inclusive rate; or

• One all-inclusive charge rate for accommodations and another for ancillary services, not including the cost of blood in the all-inclusive rate.