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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Payer sources for senior living, nine ways

Dec 14, 2018
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Billing Alert for Long-Term Care

Senior living (also referred to as assisted living) is a cash-reliant industry, often paid for by the residents themselves. In contrast to nursing homes or skilled nursing facilities, Medicare is not generally an option for senior living facilities because these companies do not address the skill level of nursing care facilities. Nevertheless, even though senior living care is technically less expensive than skilled nursing home care, it is far from being cheap. In 2016, the national average for assisted living was $3,628 per month. However, senior living care can vary considerably from approximately $3,000 to up to $8,000 each month. The variation in price is often reflective of geographic regions and the extent of offerings found in the senior living facility.

Tools to conduct an admission audit on your facility

Dec 14, 2018
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The Bottom Line

An admission audit generally occurs five days after an admission (not too early/not too late). The goal is to capture the completion of assessments, care plans, accuracy in medication reconciliation, and orders from the hospital. Depending on the findings, an opportunity for correction via late-entry documentation can occur. Download these admission audit and admission care plan/care card audit checklists to perform an audit on your facility to ensure you’re prepared for the real thing.

Billers’ Association 2019 quarterly webcast dates available, register now!

Dec 14, 2018
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The Bottom Line

As part of your Billers’ Association for Long-Term Care (BALTC) membership, you have access to a webcast each quarter hosted by BALTC Director of Content Brianna Shipley with panelist Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro, and a select BALTC advisory board member. Panelists will discuss a variety of relevant and timely topics, including industry trends, updates, and best practices. Our members will receive guidance from, share opinions with, and have their questions answered by Medicare billing and reimbursement experts!

GAO: New payment rates for Part B lab tests may lead to billions in overpayments

Dec 14, 2018
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The Bottom Line

Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office

CMS established new payment rates for Medicare Part B laboratory services, effective in 2018. CMS was required under the Protecting Access to Medicare Act of 2014 (PAMA) to base the new rates on private payer data rather than on historical laboratory fees, which were typically higher than the rates paid by private payers. CMS is gradually phasing in reductions to Medicare payment rates, limited annually at 10% from 2018 to 2020, as outlined in PAMA.

New member resource for your compliance & ethics program

Dec 07, 2018
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The Bottom Line

As a result of updated survey protocols published in Appendix PP of the State Operations Manual on March 8, 2017, SNFs must have a compliance & ethics program in place by November 28, 2019. Implementing written policies and procedures is one element suggested by CMS to achieve a successful program, and having policies and procedures for the billing department is no exception. Download our Sample Policy for Reporting Overpayments to ensure that any known overpayment received by a federal healthcare program is appropriately refunded to avoid losing revenue dollars.

Case study: Consolidated billing, major category I

Dec 07, 2018
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The Bottom Line

Background: To illustrate the different billing requirements that apply to professional and technical components of a service, consider Malcolm, a beneficiary who visits the physician office in the midst of a Part A SNF stay to receive a chest x-ray. The physician performs the x-ray, then interprets the results. The administration of the x-ray constitutes the technical component, whereas the interpretation of the results represents the professional component of the total x-ray service.

KX modifier amounts announced for CY19

Dec 07, 2018
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The Bottom Line

The annual per-beneficiary incurred expense amounts are now known as the KX modifier thresholds. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. CMS recently posted a MLN Matters article with these amounts for CY2019, which were lowered by the BBA of 2018 which are as follows.

Ambulance Services Included & Excluded Under SNF Consolidated Billing

Dec 05, 2018
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The Bottom Line

If an ambulance is needed to facilitate the provision of a CB category III service, the trip should be accounted for in the SNF’s consolidated bill. Ambulance trips for category III services are not excluded from consolidated billing, regardless of whether or not they meet the medical necessity criteria. Download this quick reference tool, Ambulance Services Included & Excluded Under SNF Consolidated Billing, to identify which ambulance services are included and excluded from SNF consolidated billing.

Civil monetary penalties to fund new CMS quality improvement initiative

Nov 30, 2018
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The Bottom Line

CMS announced a three-year quality improvement initiative in a press release on November 20, 2018. The Civil Money Penalty Reinvestment Program (CMPRP) aims to improve residents’ quality of life by equipping nursing home staff, administrators, and stakeholders with technical tools and assistance to enhance resident care. The CMPRP is funded by federal civil money penalties, which are fines nursing homes must pay CMS by law when they are noncompliant with certain regulations and there are serious concerns about the safety and quality of care they provide.

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