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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Trump administration’s proposed rule aims to penalize legal immigrants for using Medicaid

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The Bottom Line

The Trump administration’s proposed rule issued on Wednesday raises concerns about the health of public health efforts and threatens healthcare, nutrition, and housing assistance for millions of low-income legal immigrant families. The proposal, published in the Federal Register by the Department of Homeland Security, would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency, reports Modern Healthcare.

Did you miss our quarterly webinar? Here’s how to listen.

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The Bottom Line

If you couldn’t attend the Billers’ Association for Long-Term Care’s quarterly webinar earlier this month, here’s what you missed! Click here to access the recording. Postacute regulatory specialist for HCPro, Stefanie Corbett, DHA, reviewed current regulatory updates and what they mean for SNF reimbursement, including the flu vaccine payment allowance and code updates, the latest changes to the MDS effective October 1, 2018, and a reminder of reporting requirements for the SNF QRP and VBP.

CMS publishes 2016 SNF PUF data

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The Bottom Line

CMS has posted the fourth release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2016. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. 

Implications of consolidated billing under PDPM

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Billing Alert for Long-Term Care

Under CMS’ new payment model to be implemented October 1, 2019, the Patient-Driven Payment Model (PDPM), clinical complexity will be the focus of increased payment opportunity. Facilities will receive greater reimbursement for more acute (sicker) patients, such as those with certain cancers, HIV/AIDS, multiple pressure ulcers, and morbid obesity.

Such residents tend to have greater care costs (drugs, equipment, supplies, etc.). Consolidated billing (CB) requirements describe what care costs are covered by the skilled nursing facility (SNF) prospective payment system (PPS) and occasionally Medicare Part B.

Are you billing Occurrence Code 22 correctly?

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The Bottom Line

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim.

CMS invites Medicare Part A providers to learn new Medicare Cost Report e-filing system

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The Bottom Line

Register for Medicare Learning Network events. Medicare Part A providers: Learn how to use the new Medicare Cost Report e-Filing (MCReF) system. Use MCReF to submit cost reports with fiscal years ending on or after December 31, 2017. You have the option to electronically transmit your cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. You must use MCReF if you choose electronic submission of your cost report. For more information, see the MCReF MLN Matters Article and MCReF webpage.

Billing for the flu vaccine

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Billing Alert for Long-Term Care

As clinical teams work diligently to educate their residents about the flu, and offer and/or administer the influenza virus (or flu) vaccination to residents, the billing team should ensure that costs for the vaccination are captured and revenue is not left on the table for the billable service.

Medicare Part B pays 100% of flu vaccine costs, including costs associated with its administration. Part D benefits do not cover these costs. Payment is made on a cost basis for the vaccine and is based on the physician fee schedule for the administration. Deductibles and coinsurance do not apply to influenza, pneumococcal, or hepatitis B vaccines.

Your Medicare Advantage plan may be inappropriately denying payments

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The Bottom Line

Medicare Advantage Organizations (MAO) may be gaming the capitated payment model to increase their profits, an Office of Inspector General (OIG) report suggested. The September 25 report details an OIG study undertaken to address concerns that MAOs are inappropriately denying authorization of services for beneficiaries or payments to providers.

CMS publishes corrections to RUG-IV federal per diem rates & MDS item in SNF PPS final rule

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The Bottom Line

The Centers for Medicare & Medicaid Services published the following summary of errors published in the FY2019 SNF PPS final rule. The correction to these errors are found in Section IV of the correction notice and are effective October 1, 2018. CMS also republished the wage indexes in Table A and B on the CMS website to at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html to correct errors made there.

Q&A: Getting to know PDPM

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Billing Alert for Long-Term Care

Q: When will the reimbursement rates begin decreasing?

A: After the 20th day of a resident’s stay, the PT/OT rate components will decrease by 2% every 7 days. The NTA rate component will be reduced after the third day of a resident’s stay by two-thirds of the initial NTA rate component amount.

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