The Social Security Act allows CAHs and other small rural hospitals to enter into “swing bed” agreements with CMS. Under these arrangements, in addition to providing acute inpatient services, such hospitals are permitted to provide extended care services that would normally be furnished in a skilled nursing facility (SNF). When provided under a swing bed arrangement, SNF extended care services are referred to as “swing bed” services. In a swing bed hospital, an inpatient bed may actually swing from one level of care to another (e.g., acute to swing or swing to acute), depending upon a particular patient’s need.
Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed?
This week’s updates include July quarterly update to 2016 annual update of HCPCS codes used for SNF Consolidated Billing (CB) enforcement; updates to Pub. 100-04, Medicare Claims Processing Manual, Chapters 4 and 5 to correct remittance advice messages; and more!
CMS proposed a test this week for a new Medicare Part B prescription drug plan that would replace its previous policy of paying physicians and outpatient hospital departments the average sales price (ASP) plus 6%.
CMS will require revenue code and HCPCS code reporting for rural health clinics starting April 1. CMS created more questions than answers during the recent Rural Health Open Door Forum call and in the guidance published in the last few months. This article will help sort through the issue.
Q: Last week you talked about the MAC editing for medically necessary services related to the local coverage determination (LCD). What do we do if we have a situation where we believe that the list of covered diagnoses is not complete? How do we get our MAC to consider that information? We placed a call, but nothing has happened and we’ve received no response.
