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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RCS-1 CMS case-mix pre-rule: Get ready for big changes

June 2, 2017
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Billing Alert for Long-Term Care

Changes are coming to the SNF prospective payment system (PPS)—possibly the largest changes the industry has seen since the implementation of RUGs in July 1998.

On April 27, a Summary of Advance Notice was published in the Federal Register titled Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities: Revisions to Case-Mix Methodology. The purpose of this pre-rule is to solicit public comments on potential options for revising certain aspects of the SNF PPS payment methodology to improve its accuracy, based on the results of CMS’ SNF PPS Payment Model Research project.

 

De-stressing distressed long-term care facilities: Challenges they currently face and solutions to help them thrive

June 7, 2017
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Billing Alert for Long-Term Care

External pressures such as lower reimbursement rates and an overall shift in policy by the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies, and internal pressures including higher acuity residents, operational decisions, and a competitive environment for residents and employees, have put significant financial and operational pressures on long-term care facility operators.

Part B Outpatient Therapy Q&A

June 21, 2017
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Billing Alert for Long-Term Care

Editorial note: This Q&A is excerpted from our soon-to-be published title, Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS and Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC.

Q: What are the circumstances that allow us to bill under Medicare Part B?

 A: When services are provided in a skilled nursing facility (SNF), Medicare Part B may be billable for residents who have exhausted their Part A benefits or are ineligible for benefit days under Part A, outpatient physical therapy (PT), outpatient occupational therapy (OT), and outpatient speech language pathology (SLP).  These therapy services are very common among SNF residents as they rehab from an acute condition such as a stroke or joint replacement.  Many SNF residents benefit from short or long term therapy services to help regain movement, strength and activities of daily living. Part B therapy claims are frequently subject to medical review and denial, making it important that the details are billed correctly and that documentation exists to support the services. 

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