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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SNF ABNs: Avoiding common errors that lead to Medicare Part A denials

August 16, 2017
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Billing Alert for Long-Term Care

This Q&A is from our June 14, 2017 webcast with postacute regulatory specialist Stefanie Corbett, DHA.

 

Q: Facilities can use either the 10055 form or the CMS SNF denial letters, is that correct?

A: There are different ABNs required for different scenarios. Each of the forms is included in the presentation and handouts. Make sure that you follow the scenario chart to ensure that you use the appropriate form number for each scenario.

Q: Should Form 10055 be used to notify a Medicare beneficiary of the end of skilled services?

How to determine overall facility star rating

August 8, 2017
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Billing Alert for Long-Term Care

When determining how many points each of your Quality Measures (QM) is receiving, the 5-star report is used to compare the facility rating to the specific ranges of the cut point tables for each measure. Each measure has its own cut point table to determine how many points are assigned at each threshold. The higher the number of points, the higher the ranking (between one and five stars for the QM domain overall). This star rating is then compared to the health inspection stars and the staffing stars to determine the final overall facility star rating.

 

Communication skills to fuel success throughout the facility

August 2, 2017
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Billing Alert for Long-Term Care

As regulatory and legislative changes continue to reshape care and payment paradigms throughout healthcare, providers need to ensure their core operational and clinical practices are sustainable; a reality confirmed by respondents to a current HCPro feedback survey, who have thus far identified staffing concerns (e.g., education and retention), quality care, and compliance as top SNF priorities for the year ahead.

Accounting for Medicare A coinsurance from Medicaid or Managed Medicaid bad debt

August 2, 2017
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The Bottom Line

You may be writing off bad debt that is not bad debt at all.  Some managed care plans will pay a lump sum to facilities for their coinsurance once a year.  Knowing what your contracts say is very important! Be sure to track these balances, because Medicare and Managed Care plans generally pay something toward them, but they won’t if you don’t keep track!  This is very important for your cost reporting as well.

How to Employ Strategic Opportunities for Marketplace Differentiation

July 26, 2017
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Billing Alert for Long-Term Care

The challenge for skilled nursing facility (SNF) providers today is less about census and more about payer mix.

Providers must develop a strong and replicable quality mix—one that, with the application of good marketing strategy and business development techniques, sources desired referrals consistently and dependably. In this manner, the SNF achieves occupancy and revenue targets consistent with its business or strategic plan. From a business development perspective, the strategy and thus the results are organic—naturally occurring as a result of operational standards and care outcomes.

SNF reimbursement cuts are less than three months away

July 26, 2017
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The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) released a memo alerting nursing homes that reimbursement cuts are less than three months away for any SNF that does not submit required quality data. Beginning with FY 2018 (October 1), and each subsequent year, if a SNF does not submit required quality data, their payment rates for the year are reduced by 2 percentage points for that fiscal year.

Billing for pneumococcal pneumonia, influenza virus, and Hepatitis B vaccines

July 20, 2017
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Billing Alert for Long-Term Care

As residents age, their health needs become more complex and many find themselves coping with chronic conditions such as heart disease, lung disease, and diabetes. For all residents in a long-term care facility, but for residents with chronic conditions especially, vaccines are an important part of decreasing the risk for further health complications. While it is the job of nurses and CNAs to administer vaccines, it’s up to the billers to ensure your facility is being reimbursed appropriately for these common services.

CBO predicts 32 million will be without health coverage in 2026 with new repeal-and-delay bill

July 20, 2017
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After the Senate’s recommendation for repeal-and-replace of the Affordable Care Act (ACA) failed due to lack of support, Majority Leader Mitch McConnell is now suggesting a repeal-and-delay strategy that, if passed, is predicted will leave 32 million individuals without health coverage by 2026, and 17 million without coverage by next year. That’s 1 million more than were predicted to be without coverage under the initial repeal-and-replace tactic.

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