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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Vol. 20, Issue 5, May 24, 2018

Patient-driven payment model, survey, and quality: Understanding MDS accuracy and what you need for success

May 11, 2018
Billing Alert for Long-Term Care

On Friday, April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published a highly anticipated proposed rule containing a recommendation to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV). The proposed model, Patient-Driven Payment Model (PDPM), significantly revises the Resident Classification System, Version I (RCS-I), which was introduced as a potential RUG-IV replacement last April in an Advanced Notice of Proposed Rulemaking.

Q&A: Post-Medicare audit processes

May 18, 2018
Billing Alert for Long-Term Care

Q: What should we do if we feel that the auditor’s findings are blatantly wrong?

A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.

Protecting electronic resident health information

May 24, 2018
Billing Alert for Long-Term Care

The use of electronic health records (EHR) is a growing trend in long-term care today. Acute care settings have led the way in replacing paper records, resulting in improved quality and efficiency, as well as lower costs. As long-term care facilities are following their lead, they should not allow these potential benefits to overshadow the increasingly challenging necessity to secure and protect resident health information.

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