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Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care is a membership community created specifically for long-term care billing professionals. This national association provides members with a resource of continuously updated tools, billing-specific education, and reimbursement and regulatory guidance. Become a member today and join your long-term care billing colleagues as you navigate the evolving world of post-acute care billing.

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Featured Article

CMS delays the expansion of bundled payment programs

March 21, 2017
 | 
The Bottom Line

The Centers for Medicare and Medicaid Services (CMS) has delayed the expansion of two bundled payment programs, according to an interim final rule posted to the Federal Register. The bundled payment programs for hip and knee replacements was slated to expand March 21, 2017, while a new stroke and heart attack care program was planned for implementation the same day.

News & Analysis

FREE: Please join us tomorrow for the Billers' Association quarterly webcast

March 28, 2017
 | 
The Bottom Line

Please join us for the Billers' Association quarterly webcast. Each quarter, an industry expert will cover industry hot topics, as well as billing challenges, in this webcast. Each webcast will be 30 minutes in length, followed by a 15 minute live Q&A when members can ask questions and get direct feedback. Webcasts will be from 1-1:45pm EST on the following dates:

Wednesday, March 29, 2017
Wednesday, June 21, 2017
Wednesday, August 16, 2017
Wednesday, November 8, 2017

SNF merger and acquisitions: The provider number trap

March 24, 2017
 | 
Billing Alert for Long-Term Care

Over my career, I have done a fair amount of merger and acquisition (M&A) work, including:

  • Continuing care retirement communities (CCRC)
  • Skilled nursing facilities (SNF)
  • Home health agencies (HHA)
  • Physician practices
  • Hospices

While each deal has many nuances and issues, none can be as confusing to navigate as the federal payer issues—specifically, the provider number. For SNFs, HHAs, and hospices, an acquisition that is not properly vetted and structured can have severe repercussions post-closing, if provider liabilities existed pre-close and were unknown and/or unknowable. Even the best due diligence cannot ferret out certain provider number–related liabilities.

The Medicare provider number is the unique reference number assigned to a participating provider. When initially originating as a provider, the organization must apply for provider status, await accreditation (for SNFs, this is done via a state survey; for HHAs and hospices, it is via private accreditation), and then get ultimate approval by Medicare/HHS. As long as the provider that has obtained the number remains in good standing with CMS—meaning it hasn’t had its provider status/agreement revoked—the provider may participate in, and bill, Medicare and Medicaid (as applicable).

CMS delays the expansion of bundled payment programs

March 21, 2017
 | 
The Bottom Line

The Centers for Medicare and Medicaid Services (CMS) has delayed the expansion of two bundled payment programs, according to an interim final rule posted to the Federal Register. The bundled payment programs for hip and knee replacements was slated to expand March 21, 2017, while a new stroke and heart attack care program was planned for implementation the same day.

Obstructing audits could lead to Medicare exclusion for long-term care facilities

March 17, 2017
 | 
Billing Alert for Long-Term Care

Under a final rule published on January 12, 2017, by the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the agency’s authority to exclude facilities from Medicare funding was expanded to include any individual or entity found guilty of audit obstruction. Prior to this rule, exclusion authority was limited to those convicted of obstructing criminal investigations. The rule became effective on February 13, 2017.

 

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