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 Resource

Policy and procedure to help prevent costly medication discrepancies

Dec 27, 2018
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The Bottom Line

The long-term care environment is one of the most complicated and challenging clinical settings in all of medicine, placing residents who reside in a nursing home or SNF at substantial risk of adverse outcomes related to medication use. At any point in time, there are approximately 1.5 million people living in 15,000+ nursing homes across the country, with around 2.8 million having a skilled nursing facility (SNF) stay at some point throughout the year. With the complex, heavily regulated nursing home admission process and the lack of any standardized drug regimen review (DRR) process, there are many opportunities for medication errors or potentially clinically significant medication issues (PCSMI) to occur.

News & Analysis

Reminder to pharmacies for correctly billing Part B claims using KX modifier for immunosuppressive drugs

Jan 11, 2019
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The Bottom Line

In response to a 2017 OIG report noting that some pharmacies billed Medicare incorrectly for Part B claims using the KX modifier for immunosuppressive drugs, CMS has published several resources to clarify manual instructions and help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources include the following:

Triple check monthly billing review

Jan 11, 2019
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The Bottom Line

Implementing a triple check process in your facility not only helps improve therapy and nursing documentation, but can also assist in monitoring and identifying areas of discrepancy and opportunity to improve the management of the Medicare Part A process. Performing a monthly billing review can help ensure that critical elements are present on the MDS to ensure optimum payment. Download our triple check monthly billing review tool to keep each item organized and tracked.

What you need to know about the updated MDS items sets for 2019

Jan 11, 2019
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The Bottom Line

CMS posted a new DRAFT version of the 2019 MDS item sets (v1.17.0) last week. This version is scheduled to become effective October 1, 2019, giving facilities until then to update their software with the new MDS questions and answers. Downloadable files can be accessed here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html

HCPro’s post-acute regulatory specialist Stefanie Corbett, DHA, reports the following changes.

Don’t let your HIPAA policies and procedures go stale

Jan 11, 2019
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Billing Alert for Long-Term Care

For HIPAA covered entities (CE) that maintain poor policies and procedures related to HIPAA compliance—those that are unfinished in draft form, not updated in years, and basically not followed to the letter—their lassitude has cost them dearly.

Just look at some of the settlements OCR has struck with CEs and business associates (BA) in the past five years. Many of those settlements include findings that organizations had poorly maintained policies and procedures. This has increased the settlement amounts and in turn led OCR to issue strict consent decrees requiring these entities to update and maintain their HIPAA-related policies and procedures.

Don’t forget to register for next week’s webcast!

Jan 11, 2019
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The Bottom Line

On Wednesday, January 16, 12:00pm – 1:00pm, ET, BALTC members are invited to join our quarterly webcast. The presentation will begin with a few membership update announcements from director of content, Brianna Shipley, followed by some important regulatory updates presented by HCPro’s post-acute regulatory specialist, Stefanie Corbett, DHA. Finally, BALTC advisory board member and senior consultant for LW Consulting, Jennifer Matoushek, MBA/HCM, CPC, will explain to listeners how the SNF Value-Based Purchasing Program can affect their Medicare rates, as well as an overview of what to expect from the program in 2019. After the presentation, audience members will be able to submit questions of our speakers.

Register here and don’t forget to pack a lunch!

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