CMS Pub. 100-04, ch. 6, § 100.1

PM A-02-016

For their SNF-level inpatients, rural (non-CAH) swing bed hospitals must submit all

services that are not specifically excluded from consolidated billing on their Part A swing

bed bill (TOB 18x). However, they are eligible for additional payment outside the

bundled SNF PPS rate for those services that are excluded from the SNF Part A

consolidated billing requirements. Further, because the swing bed hospital itself still

remains subject to the hospital bundling requirements specified in §1862(a)(14) of the

Act and in 42 CFR 411.15(m), it retains the Medicare billing responsibility for any

excluded services to which the hospital bundling provision applies. Accordingly, it

would use a separate inpatient Part B claim to bill for such services (see §10.2 of this

chapter).

As noted above, if a swing bed hospital furnishes a service or supply to a beneficiary

receiving SNF-level services, which is excluded from the Part A PPS rate, the swing bed

hospital may submit a separate bill to the A/B MAC (A) for the SNF PPS-excluded

service. This bill must use TOB 13x with all appropriate revenue codes, HCPCS codes,

and line item date of service billing information and will be paid as inpatient Part B

services under the Outpatient Prospective Payment System (OPPS). (By contrast, those

services bundled into the SNF PPS rate may not be billed separately, and must all be

included on the Part A swing bed bill (TOB 18x).) A list of services that are excluded

from the SNF PPS rate is found in §§20.1 - 20.4 above.

Likewise, swing bed hospitals may file bills with the A/B MAC (A) for Part B Ancillary

services furnished to beneficiaries who are not in a Part A PPS swing bed stay. Such

claims are billed as inpatient Part B services, and are paid under the OPPS.