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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Q&A from Biller’s Talk

Oct 26, 2018
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The Bottom Line

Q: If a resident has a United Healthcare Medicare Advantage Plan and wants to disenroll from it and enroll in traditional Medicare, if we do it before the 15th of the month they will have coverage by 10/1/18 correct? If so will they have a lapse in coverage?  

A: As long as the resident had a qualifying event then there is no limit on when the disenrollment notice is received. Therefore a resident in a SNF can disenroll at any time during a month and the disenrollment will take effect on the 1st of the following month. The regulations state, however, that it is usually good practice to try to submit the disenrollment prior to the 15th of the month to allow them to process the paperwork and notify CMS.

CMS releases 2019 Medicare Parts A&B premiums and deductibles

Oct 19, 2018
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The Bottom Line

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

Your Medicare Advantage plan may be inappropriately denying payments

Oct 05, 2018
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The Bottom Line

Medicare Advantage Organizations (MAO) may be gaming the capitated payment model to increase their profits, an Office of Inspector General (OIG) report suggested. The September 25 report details an OIG study undertaken to address concerns that MAOs are inappropriately denying authorization of services for beneficiaries or payments to providers.

Combing patient records for additional diagnosis codes reaps massive returns for Medicare Advantage plans

Sep 07, 2018
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The Bottom Line

Under traditional Medicare in a SNF, diagnosis codes don’t have a significant impact on reimbursement. Medicare Advantage plans, however, contain a built in incentive that encourages providers to code all diagnoses possible in order to receive optimal payment, which in recent cases has led to retrospective chart review of patients’ medical charts to identify additional diagnosis codes for submission to CMS.

Emphasis on shorter lengths of stay may cause identity crisis among long-term care facilities

Aug 03, 2018
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Billing Alert for Long-Term Care

Beneficiary enrollment in Medicare Advantage plans is on the rise, increasing from 5.3 million in 2013 to 19 million in 2017, according to information published by PLOS Medicine. A study released by the nonprofit advocacy organization in June compared postacute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries with hip fractures in the United States. The results? Although MA beneficiaries experienced shorter lengths of stay and less rehab, their return to the community was more successful and their readmission rates were significantly lower compared to the FFS beneficiaries.

Should traditional Medicare cover chronic care?

May 10, 2018
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The Bottom Line

Considering adding chronic care as a benefit under traditional Medicare coverage started with the idea of adding it under Medicare Advantage (MA) for the 2019 benefits package. MA program managers presented the idea earlier this week in Washington, according to ThinkAdvisor, and although it was well-received, feedback from witnesses included a suggestion that adding the benefit shouldn’t exclude beneficiaries who receive traditional Medicare.

Calling all experts! Get involved in educating other long-term care professionals.

Apr 26, 2018
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The Bottom Line

The Billers’ Association is seeking long-term care managers, revenue cycle enthusiasts, and billing professionals to join our growing ad-hoc list of experts interested in contributing to articles in our monthly publication, Billing Alert for Long-Term Care. This digital newsletter provides expansive regulatory coverage, including MDS changes, reimbursement issues, and expert advice and analysis to help improve job performance in all aspects of the revenue cycle management system.

CMS raises Medicare Advantage pay rates by 3.4% for 2019

Apr 06, 2018
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The Bottom Line

In a final rule published on Monday, April 2, 2018, CMS announced 2019 payment updates for Medicare Advantage, which will rise by 3.4%, an increase from the 2.95% raise in 2018. The agency also announced that they are “reinterpreting the standards for health-related supplemental benefits in the Medicare Advantage program to include additional services that increase health and improve quality of life, including coverage of non-skilled in-home supports and other assistive devices."

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