Medicaid Billing

1. Medicaid Billing • If a Medicare/Medicaid patient’s Medicare Part A benefits are exhausted: • swing-bed services may be submitted to Medicaid for reimbursement at the Medicaid per diem rate established by the Department. • Claims must be filed on the UB-04 Claim Form and submitted within six (6) months from month of service.

2. Medicaid Billing • The UB-04 claim form should be filed with the Medicare Explanation of Benefits attached. • The attachment must state the patient’s Medicare benefits are exhausted and include the last date of Medicare entitlement. • Claims may be submitted via mail or web.

3. Reimbursement • Swing-bed providers will be reimbursed a prospective rate per patient day. • This rate is the statewide average Medicaid per diem paid to skilled nursing facilities for routine services furnished during the previous calendar year.

4. Medicaid Manual • Routine services are defined in the Medicaid Policies and Procedures for Swing Bed Services.

5. All nursing services (excluding private duty nurses), medical social services, physical therapy, speech therapy, restorative nursing care, tray service, durable medical equipment (includes but is not limited to beds, bed rails, walkers, wheelchairs), incontinency care and incontinency pads, hand feedings, special mattresses and pads, massages, syringes, enemas, nursing supplies and dressings, extra linens, assistance in personal care and grooming, laboratory procedures not requiring laboratory personnel, non-prescription drugs such as antacids, aspirin, suppositories, milk of magnesia, mineral oil, rubbing alcohol, prophylactic medications (i.e., influenza vaccine, etc.), and other items not on the Medical Assistance Drug List but which are distributed or used individually as ordered by the attending physician, and routine personal hygiene items and services including but not limited to shampoo, hair conditioner, comb, brush, bath soap non-legend disinfecting soaps or specialized cleansing agents when indicated to treat special skin problems or to fight infection, razors, shaving cream, toothbrush, toothpaste, denture adhesive, denture cleaner, dental floss, petroleum jelly, moisturizing lotion, tissues, cotton balls, cotton swabs, deodorant, towels, washcloths, hospital gowns, nail care, hair care, bathing, and shaving. In addition, supplies such as oxygen, catheters, catheter sets, drainage apparatus, intravenous solutions, administration sets and water for injections are to be covered under the approved reimbursement rate.

6. Reimbursement • Ancillary services such as laboratory, radiology and certain prescription drugs must be billed and reimbursed separately under the appropriate Medicaid program. • For example, radiology services provided in the outpatient department of the hospital should be billed as hospital outpatient services.

7. Reimbursement • Medicaid will reimburse the Medicare Part A coinsurance for Medicare/Medicaid recipients. • Medicaid reimbursement will be reduced by the recipient’s liability. • The hospital is responsible for collecting the recipients liability portion.

8. Medicaid Cost Reports • There will not be a year-end cost report settlement for swing-bed services. • There is no swing-bed services cost report. • Medicaid swing-bed program data should not be included in the Medicaid Cost Report settlement data. • The Medicaid routine swing-bed days should be excluded from the hospital’s Medicaid routine days on the cost report.

9. Comparison MEDICAID SWING BED