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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Two-year budget deal repeals therapy caps, cuts skilled nursing spending by $1.96 billion

February 14, 2018
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The Bottom Line

Last week, President Donald Trump signed a two-year federal budget deal that left long-term care providers sighing with relief at the repeal of therapy caps for Medicare Part B beneficiaries retroactive to January 1, followed by a sigh of disappointment with a $1.96 billion cut to skilled nursing spending. The cuts include a payment reduction of 15% for therapy assistants, making the actualization of the wished for therapy cap repeal bittersweet.The budget deal also reveals a 2.4% increase in SNFs’ Medicare reimbursement rates in fiscal year 2019 and a 1.5% increase in Medicare reimbursement rates for home health agencies in 2020.

Have you heard? We’ve added a NEW Administrator’s Bootcamp!

February 14, 2018
 | 
The Bottom Line

The Long-Term Care Administrator’s Boot Camp offers skilled nursing facility administrators a review of Medicare regulations and best practices for ensuring the provision of high-quality services, resident satisfaction, quality survey outcomes, and proper payments. Specifically, The Long-Term Care Administrator’s Boot Camp focuses on how Medicare regulations guide clinical and financial operations, and explains the role of the administrator in admissions, documentation, MDS, billing, coding, compliance and ethics, and quality improvement.

Come join us!

Are you up to speed on the new evaluation and reevaluation codes?

February 9, 2018
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Billing Alert for Long-Term Care

On January 1, 2017, two significant changes went into effect in the therapy world:

The Centers for Medicare & Medicaid Services (CMS) eliminated physical therapy (PT) and occupational therapy (OT) evaluation codes 97001 and 97003 and replaced them with three new tiered evaluation codes that contain descriptors based on the resident’s level of complexity (low, moderate, and high); and PT and OT reevaluation codes 97002 and 97004 were replaced with new CPT codes

Although these changes are over one-year-old, it’s important that clinicians take a step back in 2018 and revisit these new code sets to ensure they’re up to speed and coding correctly in the New Year. Keep in mind that these new codes should be used with all HIPAA-compliant payers, including Medicare Part A and Part B (to include RUGs currently, and RCS-1 if/when the industry transitions to that payment model), managed care, and private insurances/. This article will discuss the specifics of the new evaluation/reevaluation codes, when to use them, and billing implications of using the codes. 

Training strategies to help the business office overcome common collections challenges

February 6, 2018
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The Bottom Line

There are strategies you can implement to help overcome common collections challenges. Becky Ziviski, CEO of Profit Without Census, knows—because she’s been there. As a licensed nursing home administrator and certified public accountant, she not only understands the nuances of being an effective leader in long-term care, but she also has a laundry list of evidence-based tips and tricks for helping facilities save tens of thousands of dollars.

Ziviski offers several approaches that you can start implementing immediately to overcome common collections challenges, as well as other cost-saving strategies to help the entire interdisciplinary team save big. To learn her secrets, listen in to her 60-minute live webinar, Profit Without Census: How to Achieve Up to $63K in Cost Savings, on Wednesday, February 7, 1:00-2:00pm, ET as she provides effective budgeting strategies to help facilities achieve up to $63k in cost savings across the board. Participants will receive continuing education credits from the National Continuing Education Review Service (NCERS) of the National Association of Long-Term Care Administrator Boards (NAB).

OIG investigations to keep in mind in 2018

February 2, 2018
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Billing Alert for Long-Term Care

In the Office of Inspector General's (OIG) FY17 Work Plan, the agency outlined its plans for 2017, stating its intended focus on nursing home complaints and care area management, such as falls and abuse/neglect issues, as well as a continued dedication to investigating Medicare fraud and abuse. As we've seen through numerous media outlets and updates on the latest settlements, the OIG followed through with its intentions.

Index 2017

January 26, 2018
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Billing Alert for Long-Term Care

Looking for a specific article? All of your 2017 BALTC articles, indexed in one place, just for you.

New voluntary bundled payment model announced

January 26, 2018
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The Bottom Line

On January 9, CMS’ Innovation Center announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. Interested in learning more?

Tips to win an appeal

January 19, 2018
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Billing Alert for Long-Term Care

Without every “i” dotted and every “t” crossed on a claim, an overpayment may result, even if the services rendered were necessary for the patient. The appeals process is designed to give providers a chance to explain their case; it’s also a mechanism to make sure an audit has been properly conducted. Mistakes happen, even among auditors, who have the leverage to demand large amounts of money in refunds. As a result, there must be some checks and balances in the system, and if done correctly, the appeals process is that balance. The following tips may not help you win every appeal, but they certainly won’t hurt.

 

New Medicare Card Project Special Open Door Forum — January 23

January 19, 2018
 | 
The Bottom Line

Join CMS on Tuesday, January 23 from 2:00 to 3:00 pm ET for a special open door forum. This call will educate State Medicaid Agencies, Medicaid providers, Managed Care Organizations, Medicaid partners, and other Medicaid stakeholders about the change from Social Security Number-based Health Insurance Claim Numbers to new Medicare Beneficiary Identifiers (MBIs). A question and answer session follows the presentation.

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