CAH-Rules for Critical Access Hospital Swing Beds

[Deleted User]

I came across this article in Medicare Compliance Watch and thought those in CAH CDI might find it interesting.

by Debbie Mackaman, RHIA, CPCO, CCDS

Recently, I have received many questions about two different payment concepts in regards to swing bed services provided in CAHs. I thought this would be a good time to review each one of these and include some food for thought from a compliance perspective.

The first billing issue that a facility may run into is when a patient is in a covered swing bed stay and requires a minor surgery for a condition that caused the swing bed stay or arose during the swing bed stay.

Just like in a SNF, and to be considered a covered swing bed stay, a patient must have been an inpatient in an acute care hospital for a minimum of three consecutive days (three midnights) within the 30 days prior to the swing bed admission. In addition, the skilled services must be related to a condition for which the patient received inpatient hospital services, or a different condition which develops during the appropriate swing bed stay.

In comparison, a CAH is reimbursed under the cost-based payment methodology rather than under the SNF PPS system. The latter allows separate payment to other providers under Part B for certain services that are considered excluded from the SNF Part A payment (i.e., operating room (OR), chemotherapy, dialysis).

To view the complete, detailed article that appeared on Medicare Compliance Watch, click here.