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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FAQs: Consolidated billing for SNFs

October 13, 2017
 | 
Billing Alert for Long-Term Care

Since its introduction in the skilled nursing facility (SNF) setting, consolidated billing (CB) has been one of the most routine yet misunderstood methods for SNFs to secure Medicare reimbursement.

To better grasp the complex principles, regulations, and systems that surround consolidated billing, SNFs must first have a solid foundation in Medicare Part A coverage and criteria. Without a basic understanding of this powerful insurance plan, SNFs risk committing or contributing to a number of punishable payment offenses, including improper billing, over- and underpayments, fraud, and abuse-related Medicare infractions that can carry serious ramifications, including steep penalties, exclusion from the program, imprisonment, or any combination thereof. 

 

The below Q&A contains questions that have been transcribed from our live webinar show, “Consolidated Billing for SNFs: A Close Look at the Five Major Categories,” hosted by expert speaker Janet Potter, CPA, MAS, senior manager, advisory services for Marcum LLP, and from frequently asked questions included in Potter’s new book, Medicare Guide for SNF Billing and Reimbursement. For more information on CB for SNFs, listen to the on-demand show or purchase our newly released Medicare billing guide.

What to do when you are under medical review

October 13, 2017
 | 
The Bottom Line

The main piece of legislation that guides the medical review (MR) process is Section 1862(a)(1)(A) of the Social Security Act, which states, “no payment may be made under Part A or Part B for any expenses incurred for items or services which … are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed or missing body part.” If a medical reviewer or clinician denies a claim, the claims are denied based on this authority.

 

The essential role of MDS 3.0 in RCS-1

October 6, 2017
 | 
Billing Alert for Long-Term Care

Currently, Medicare pays for services provided by skilled nursing facilities (SNF) under the Medicare Part A SNF PPS benefit on a per diem basis using the RUG-IV grouper. The most significant driver of this reimbursement model is the amount of therapy (days and minutes) provided to a Medicare resident, regardless of outcomes achieved. Through the years, many providers, government entities, and advocacy groups alike have voiced concerns over inappropriate incentives in this current reimbursement model. Caregivers of all types complained about a system that “de-incentivizes” an individualized approach to therapy treatment. Nurses felt their residents’ care was usurped by a system that didn’t consider their overarching needs. Not surprisingly, this led to overutilization; CMS estimates that in 2016, 11% of Medicare fee-for-service (FFS) dollars were paid incorrectly ($41.1 billion), with $2.8 billion of that amount being paid to SNFs for services almost entirely related to therapy.

Don’t forget the business office

September 29, 2017
 | 
The Bottom Line

One of the most important staff members in the facility is the person who informs the family that they owe money. The family will have a lasting relationship with the business office for a multitude of reasons; it is essential that they get off to a good start by introducing the business office manager and understanding the billing and financial obligations.

How to minimize bad debt

September 22, 2017
 | 
Billing Alert for Long-Term Care

Many healthcare providers spend more resources and time on collections rather than implementing best practices at the start of the revenue management cycle. The skilled nursing facility (SNF)’s annual bad debt expense should be less than 1% of its net revenue.

The best way to ensure the business office is minimizing billing and collection issues is to be proactive and ensure that insurance and demographic information (birthdate, Social Security number, etc.) is correct.

Survey preparation: How self-audit practices come from QAPI

September 15, 2017
 | 
Billing Alert for Long-Term Care

To help prepare for survey readiness, it is crucial that you regularly audit your facility practices. Many audits can be scheduled routinely, but in all cases, these audits should be performed no later than when the survey window begins. These self-audits help create the survey readiness mode for staff, as auditing creates potential opportunities for improvement through the Quality Assurance and Process Improvement (QAPI) program (determining root causes with Plan of Correction implementation). In fact, the primary source of identification of audits required often comes out of the QA/QAPI program.

CMS to grant exceptions to providers affected by Hurricane Irma

September 15, 2017
 | 
The Bottom Line

CMS is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to acute care hospitals, PPS-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, long-term care hospitals, and ambulatory surgical centers located in areas affected by Hurricane Irma due to the devastating impact of the storm.

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