FREE: Please join us tomorrow for the Billers' Association quarterly webcast

March 28, 2017
 | 
The Bottom Line

Please join us for the Billers' Association quarterly webcast. Each quarter, an industry expert will cover industry hot topics, as well as billing challenges, in this webcast. Each webcast will be 30 minutes in length, followed by a 15 minute live Q&A when members can ask questions and get direct feedback. Webcasts will be from 1-1:45pm EST on the following dates:

Wednesday, March 29, 2017
Wednesday, June 21, 2017
Wednesday, August 16, 2017
Wednesday, November 8, 2017

SNF merger and acquisitions: The provider number trap

March 24, 2017
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Billing Alert for Long-Term Care

Over my career, I have done a fair amount of merger and acquisition (M&A) work, including:

  • Continuing care retirement communities (CCRC)
  • Skilled nursing facilities (SNF)
  • Home health agencies (HHA)
  • Physician practices
  • Hospices

While each deal has many nuances and issues, none can be as confusing to navigate as the federal payer issues—specifically, the provider number. For SNFs, HHAs, and hospices, an acquisition that is not properly vetted and structured can have severe repercussions post-closing, if provider liabilities existed pre-close and were unknown and/or unknowable. Even the best due diligence cannot ferret out certain provider number–related liabilities.

The Medicare provider number is the unique reference number assigned to a participating provider. When initially originating as a provider, the organization must apply for provider status, await accreditation (for SNFs, this is done via a state survey; for HHAs and hospices, it is via private accreditation), and then get ultimate approval by Medicare/HHS. As long as the provider that has obtained the number remains in good standing with CMS—meaning it hasn’t had its provider status/agreement revoked—the provider may participate in, and bill, Medicare and Medicaid (as applicable).

CMS delays the expansion of bundled payment programs

March 21, 2017
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The Bottom Line

The Centers for Medicare and Medicaid Services (CMS) has delayed the expansion of two bundled payment programs, according to an interim final rule posted to the Federal Register. The bundled payment programs for hip and knee replacements was slated to expand March 21, 2017, while a new stroke and heart attack care program was planned for implementation the same day.

Obstructing audits could lead to Medicare exclusion for long-term care facilities

March 17, 2017
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Billing Alert for Long-Term Care

Under a final rule published on January 12, 2017, by the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the agency’s authority to exclude facilities from Medicare funding was expanded to include any individual or entity found guilty of audit obstruction. Prior to this rule, exclusion authority was limited to those convicted of obstructing criminal investigations. The rule became effective on February 13, 2017.

 

The reimbursement role of the MDS 3.0

March 10, 2017
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Billing Alert for Long-Term Care

Although the main purpose of the MDS is to assist the clinical team to provide accurate, resident-centered care, the MDS has evolved to become the basis for Medicare and Medicaid state case-mix payments. The MDS is used as a data collection tool to classify Medicare residents into resource utilization groups (RUG). The RUG scores as reported in MDS items Z0100 or Z0150 are then used to bill Medicare or Medicaid.

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

March 10, 2017
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The Bottom Line

CMS has made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

Eight ways to improve the transition process between hospitals and SNFs

March 3, 2017
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Billing Alert for Long-Term Care

There are few times during a SNF stay that a resident is more vulnerable than those first several days. Often, a bad transition process only serves to exacerbate those vulnerabilities, leading to complications or rehospitalization.

In fact, a  study published in the Journal of Post-Acute and Long Term Care shows that poor coordination between hospitals and postacute care providers can have devastating consequences for residents, particularly those with higher acuity.

Exciting updates: More content, tools, and news at your fingertips!

March 3, 2017
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The Bottom Line

The challenges billing professionals tackle each day don’t wait for solutions and neither should you. That’s why The Billers’ Association for Long-Term Care is transitioning to a one-level membership to allow all members access to a lively discussion board, analysis of regulatory compliance issues, weekly news of the changes that are happening in the billing world, as well as whitepapers, and more. The Billers’ Association is a single source for all your billing, regulatory, and compliance news, tools, and best practice strategies.

The Five-Star Quality Rating System Technical User's Guide is now available!

February 28, 2017
 | 
The Bottom Line

Stay compliant with the most up-to-date Five-Star Quality Rating System. The Five-Star Quality Rating System Technical User’s Guide includes CMS’ technical guide to the Five-Star Rating System, as well as expert analysis and insight into how providers can use the guide, how ratings are affected, and what providers can do to improve their rating. Industry experts Reginald M. Hislop III, PhD, and Maureen McCarthy, RN, BS, RAC-MT, QCP-MT, provide analysis and insight to assist facilities in determining their overall facility five-star rating, employing strategic opportunities for marketplace differentiation, and driving performance with quality care that can translate to maximum star ratings.

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Free Resources

Access sample white papers, tools, analysis, and resources.