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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CMS administrator aims to make doctors’ offices a “fax free zone” by 2020

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The Bottom Line

During the ONC’s Interoperability Forum in Washington, D.C. this month CMS administrator Seema Verma announced the agency’s goal to replace fax machines used in physician offices to send patient information with consumer-friendly applications. According to Healthcare Finance News, the applications will be used by Medicare beneficiaries who will be able to “connect their claims data to the applications, services and research programs they trust.”

Consolidated billing: Navigating special cases

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Billing Alert for Long-Term Care

Oftentimes, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive processes within the skilled nursing facility (SNF). This article will help providers lay the foundation for a comprehensive billing system that safeguards against these pitfalls by highlighting special consolidated billing (CB) cases whose navigation could otherwise throw a wrench in workflows.

FY 2019 release of ICD-10-CM now available

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The Bottom Line

The National Center for Health Statistics  recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2018, through September 30, 2019, which include updated language and added specificity for classifying diagnoses. The guidelines include updated language conventions to improve coding accuracy. Per guideline I.C.1.15, “with” or “in” should be interpreted to mean “associated with” or “due to” when they appear in the Alphabetic Index (either under a main term or subterm), a code title, or an instructional note in the Tabular List. 

Emphasis on shorter lengths of stay may cause identity crisis among long-term care facilities

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Billing Alert for Long-Term Care

Beneficiary enrollment in Medicare Advantage plans is on the rise, increasing from 5.3 million in 2013 to 19 million in 2017, according to information published by PLOS Medicine. A study released by the nonprofit advocacy organization in June compared postacute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries with hip fractures in the United States. The results? Although MA beneficiaries experienced shorter lengths of stay and less rehab, their return to the community was more successful and their readmission rates were significantly lower compared to the FFS beneficiaries.

What are the experts saying about PDPM?

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The Bottom Line

If you’ve been paying attention to the progression of CMS’ new payment system to replace RUG-IV, beginning with the advanced notice of proposed rule-making published last April, when it was introduced as the Resident-Classification System, to the proposed rule published this May, when it was revamped and renamed the Patient-Drive Payment Model (PDPM), the good news is that the biggest change is behind us. The SNF PPS final rule released by CMS this week doesn’t deviate too much from the proposed rule, but as experts get a chance to read through the 424-page document, they have a mix of concerns, words of advice, and positive outlooks for change.

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