swing beg claim submitting guidlines and tips

BASIC BILLING GUIDELINES FOR SUBMITTING SWING BED CLAIMS



· Swing Bed claims must be submitted to North Dakota Medicaid on paper (UB-92 form) or electronically using the ANSI X12 4010A1 837 Institutional Health Care Claim transaction.

· Swing Bed claims must be submitted to North Dakota Medicaid using a Bill Type 181-184. Use of any other Bill Type other than 181-184 for Swing Bed claims will be invalid.

· Swing Bed claims must be submitted to North Dakota Medicaid using the following Revenue Codes when billing for:
Revenue Code 110 - 159 In-House Medicaid days
Revenue Code 169 Medicare Coinsurance
Use of any other Revenue Codes for Swing bed claims will be invalid and will be returned for correction.

· The rate established for swing bed facilities is an all-inclusive rate for routine services. Routine services include supplies, therapies, nursing supplies, equipment, transportation, and non-legend drugs. Separate billings for these items will not be paid. Enter only the Room and Board charges on the UB-92 form or electronic billing format. DO NOT ENTER ANCILLARY CHARGES. Ancillary charges that are not included in the swing bed rate, such as x-ray, lab, etc. must be billed using your hospital’s provider number as an outpatient claim (bill type 13x). Pharmacy charges must be billed on a pharmacy claim form.

· Facilities must submit a claim for every month a Medicaid resident is in your facility, even if insurance (including Medicare) has paid for the charges. You must submit a claim with a zero billing even if there is no balance left for Medicaid to reimburse. This is important because when we receive the long-term care claim (even if zero billing), it allows the system to start applying other claims we receive towards recipient liability. The claim should be submitted immediately after the month is over. Enter the entire amount in Form Locator #54 (PRIOR PAYMENTS) and zero (0) amount in Form Locator #55 (ESTIMATED AMOUNT DUE).

· Only bill for Medicare coinsurance days and Medicare coinsurance amounts using Revenue Code 169. You do not have to wait until you receive the actual payment or explanation of benefits from Medicare, just enter an estimate of the insurance payment in the other insurance field on your claim form. If the actual insurance payment received is different than the estimate used, complete an adjustment claim to correct the difference. If a claim has been denied, please correct and resubmit immediately.

· Leave Days -- Payment is not available for any period that an individual does not actually occupy a bed. If an individual leaves the facility without being discharged, for example, the individual visits relatives on a weekend; the days the individual is out of the facility will not be paid. Leave day status is determined at midnight.

· Medicaid cannot make payment for swing bed services to the swing bed provider for an individual who is receiving hospice care. The hospice is paid the swing bed rate and the hospice is responsible for payment of the swing bed services provided to a Medicaid recipient. Once a recipient has elected hospice benefits, the swing bed provider may not submit a claim for services provided while the recipient is on hospice.

· Submit Swing Bed charges monthly but DO NOT bill more than one calendar month per claim.

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