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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What to do post-audit: How to set yourself up for success

December 8, 2017
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Billing Alert for Long-Term Care

If a facility prepares itself appropriately for an audit, then the post-audit processes will be minimal. Unfortunately, that is not always the case or perhaps your facility has already undergone one and you need to know what to do now. Most audits will find some issues that will require immediate action and attention as well as long-term resolutions.

 

Flu season is here: Make sure you are billing accurately for flu vaccinations

December 1, 2017
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Billing Alert for Long-Term Care

The temperatures are dropping and all of a sudden winter is here! With the transition of the seasons, long-term care facilities must focus on prevention methods to reduce residents’ risk of contracting the influenza (flu) virus.

Prevention methods are particularly important for long-term care providers to recognize and implement due to the greater severity of the flu in seniors age 65 and older, such as increased risk for heart attack, stroke, and bacterial lung infection (i.e., bronchitis or pneumonia), as well as a negative impact on ability to function independently. Due to these increased risks, it is unlikely that a senior infected with the flu will regain his or her level of health prior to infection. The illness may even prove fatal; the CDC warns that more than 90% of flu deaths occur in people over 65.

CMS cancels two mandatory bundled-pay models

December 1, 2017
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The Bottom Line

On November 30, 2017, CMS finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients. 

Phase 2 begins tomorrow!

November 27, 2017
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The Bottom Line

Are you ready? Phase 2 begins tomorrow despite providers and provider advocates urging CMS to rethink the deadline. The new survey process will take effect on 11/28/17 as promised. However, providers will get a delay on monetary penalties for one year, CMS said.

Protecting Residents from Identify Theft

November 22, 2017
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Billing Alert for Long-Term Care

Identity theft occurs when a thief steals a Social Security number, bank or credit card account information, or other documents containing personal information in order to commit fraud or for their own financial gains. Thieves use the information to get access to the victim’s personal assets and/or open new accounts and credit lines under the victim’s identity. Also, thieves can illegally obtain professional licenses, driver’s licenses, and birth certificates. Victims of identity theft are all ages, but those ages 50 and older are especially susceptible to scammers. According to Experian, approximately 2.6 million seniors are victims of identity theft every year. There are several reasons seniors are more vulnerable, including being uneducated about scams, being too trusting of others, and wanting to be independent in decision-making. Also, seniors are less likely to take preventive measures against identity theft. UCLA psychologist Shelley Taylor studied brain imaging and found that older adults may have less activity in the area of the brain that processes risk and subtle danger. Results from a survey issued by the AARP, Inc.,  revealed that the average age of victims of fraud and identity theft was 69.

FEES Studies Q&A with Stefanie Corbett

November 22, 2017
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The Bottom Line

Do you have a question that isn’t getting answered in the forum? Email it to omacdonald@hcpro.com to be considered for a Q&A with our regulatory specialist.

Q: In the SNF setting, we have agreements with FEES providers that come to the SNF and conduct FEES studies (swallowing studies). The FEES provider charges the SNF a flat fee ($350) per study that the SNF pays to the FEES company.

 Is this service billable by the SNF to Medicare Part B when provided in the SNF but to a contracted provider?

Reduce your audit risk: How to analyze the UB-04

November 17, 2017
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Billing Alert for Long-Term Care

The UB-04 is a claim form suitable for billing multiple third-party payers. All payers will not require the use of the same data elements, so check with each payer to identify its individual requirements. In general, SNFs are required to submit the UB-04 electronically to all payers, in the 837-I format. This form can be submitted through electronic billing software programs in batch billing or through direct data entry (DDE) through the MAC. A provider filing a UB-04 should retain the copy designated “Institution Copy” and submit the remaining copies to its MAC, managed care plan, or other insurer. If a provider omits any required data, the MAC will return the claim for correction (which is called return to provider or RTP).

Case Study: Immediate Jeopardy

November 15, 2017
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The Bottom Line

A few weeks after the survey exit, the SNF receives notice that someone at a higher level within the state has classified a citation as immediate jeopardy. The surveyors have already left, and the facility was given no such indication at exit. Fortunately, this is not a common occurrence.

The transition to a unified payment system for PAC facilities could start as early as 2019, suggests MedPAC

November 10, 2017
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The Bottom Line

In response to a Congressional mandate, in 2016 The Medicare Payment Advisory Commission (MedPAC) recommended design features of a unified payment system, the post-acute-care (PAC) prospective payment system (PPS), to pay for services in the four post-acute care settings (home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals). In a meeting held last Thursday, Commissioner Carol Carter discussed how the PAC PPS design could “increase the equity of payments within each post-acute-care setting.”

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