Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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Featured Article

Are you billing Occurrence Code 22 correctly?

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The Bottom Line

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim.

News & Analysis

Did you miss our quarterly webinar? Here’s how to listen.

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The Bottom Line

If you couldn’t attend the Billers’ Association for Long-Term Care’s quarterly webinar earlier this month, here’s what you missed! Click here to access the recording. Postacute regulatory specialist for HCPro, Stefanie Corbett, DHA, reviewed current regulatory updates and what they mean for SNF reimbursement, including the flu vaccine payment allowance and code updates, the latest changes to the MDS effective October 1, 2018, and a reminder of reporting requirements for the SNF QRP and VBP.

CMS publishes 2016 SNF PUF data

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The Bottom Line

CMS has posted the fourth release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2016. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. 

Trump administration’s proposed rule aims to penalize legal immigrants for using Medicaid

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The Bottom Line

The Trump administration’s proposed rule issued on Wednesday raises concerns about the health of public health efforts and threatens healthcare, nutrition, and housing assistance for millions of low-income legal immigrant families. The proposal, published in the Federal Register by the Department of Homeland Security, would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency, reports Modern Healthcare.

Implications of consolidated billing under PDPM

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Billing Alert for Long-Term Care

Under CMS’ new payment model to be implemented October 1, 2019, the Patient-Driven Payment Model (PDPM), clinical complexity will be the focus of increased payment opportunity. Facilities will receive greater reimbursement for more acute (sicker) patients, such as those with certain cancers, HIV/AIDS, multiple pressure ulcers, and morbid obesity.

Such residents tend to have greater care costs (drugs, equipment, supplies, etc.). Consolidated billing (CB) requirements describe what care costs are covered by the skilled nursing facility (SNF) prospective payment system (PPS) and occasionally Medicare Part B.

Are you billing Occurrence Code 22 correctly?

 | 
The Bottom Line

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim.

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