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

CMS releases 2019 Medicare Parts A&B premiums and deductibles

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The Bottom Line

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

News & Analysis

MedPAC publishes resource for SNFs: Payment basics

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The Bottom Line

MedPAC released their Payment Basics for SNFs 2018 report, which provides an overview of Medicare coverage and reimbursement. You can download this resource from The Billers’ Association resource library. The report includes a map explaining how reimbursement is calculated under the current prospective payment system, Medicare daily base rates for FY19, and the RUG-IV classification system.

CMS releases 2019 Medicare Parts A&B premiums and deductibles

 | 
The Bottom Line

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

Two jurisdictions announce new Targeted Probe and Educate topic

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The Bottom Line

The MACs for the J5 (Iowa, Kansas, Missouri, and Nebraska) and J8 (Indiana and Michigan) jurisdictions (WPS Government Health Administrators) announced that CMS has authorized them to conduct a Targeted Probe and Educate (TPE) review of outpatient therapy (CPT code 97110). The announcement was made on October 15 on the WPS website. The webpage states thatThis is a required process for providers identified by Medical Review. The TPE review process incudes three rounds of prepayment or post-payment probe review with education. If high denial rates continue after three rounds or review, WPS GHA will refer the provider and results to CMS. CMS will determine any additional action, which may include but is not limited to extrapolation, referral to the Unified Program Integrity Contractor (UPIC), and/or referral to the Recovery Audit Contractor (RAC).”

473 changes to ICD-10 codes

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Billing Alert for Long-Term Care

Coding tells the detailed story of your facility’s patient care, morbidity, and sometimes demographic information. ICD-10 coding in long-term care has several purposes, including to:

  • Collect diagnostic and statistical data
  • Support clinical decision-making
  • Verify medical necessity
  • Validate need for supportive procedures, treatments, and therapies
  • Support reimbursement for services provided
  • Determine RUG scores
  • Correctly code diseases on the MDS, UB-04, medical reports, therapy treatments, and ancillaries

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. 

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