Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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CMS invites Medicare Part A providers to learn new Medicare Cost Report e-filing system

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The Bottom Line

Register for Medicare Learning Network events. Medicare Part A providers: Learn how to use the new Medicare Cost Report e-Filing (MCReF) system. Use MCReF to submit cost reports with fiscal years ending on or after December 31, 2017. You have the option to electronically transmit your cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. You must use MCReF if you choose electronic submission of your cost report. For more information, see the MCReF MLN Matters Article and MCReF webpage.

Updates to MDS 3.0 FY2019

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The Bottom Line

Changes to the Minimum Data Set (MDS) for skilled nursing facilities (SNFs) for the fiscal year 2019 include mechanical fixes (i.e. grammar, punctuation, capitalization, and text updates), clarifications and new items. Want a hard copy of this best-selling MDS 3.0 RAI User’s Manual? Check out HCPro’s version published with the latest updates on September 19, 2018. Facilities should prepare for the updates to the following sections effective October 1, 2018.

Q&A: Getting to know PDPM

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Billing Alert for Long-Term Care

Q: When will the reimbursement rates begin decreasing?

A: After the 20th day of a resident’s stay, the PT/OT rate components will decrease by 2% every 7 days. The NTA rate component will be reduced after the third day of a resident’s stay by two-thirds of the initial NTA rate component amount.

New Medicare card update

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The Bottom Line

CMS has confirmed that they are processing claims and eligibility requests with the Medicare Beneficiary Identifier (MBI), showing that providers are successfully using the new number. This week the agency began mailing new Medicare cards to people who live in Wave 6 states, which include Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, and Wyoming.

Calculating reimbursement under PDPM

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Billing Alert for Long-Term Care

Many staff members in a skilled nursing facility (SNF) have contributed to the minimum data set (MDS) under the current SNF prospective payment system, but few are able to explain how that documentation converts to a dollar amount or understand how the Centers for Medicare & Medicaid Services (CMS) defines a RUG rate. To help providers prepare for the transition from RUG-IV to CMS’ new Patient Driven Payment Model (PDPM), a calculation worksheet has been made available so staff will be able to explain how care services translate into reimbursement rates by the new payment model’s implementation date, October 1, 2019.

10 things you need to know about CMS’ final SNF PPS rule, and PDPM

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Billing Alert for Long-Term Care

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register dated August 8, 2018, the Patient-Driven Payment Model (PDPM)--the new case-mix methodology to replace RUG-IV--is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. The final rule also establishes a 2.4% market basket update, meaning an $820 million raise for SNFs beginning October 1, 2018.

Biller's Talk Q&A: Questions, concerns, and solutions from your peers

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Billing Alert for Long-Term Care

What it is: Biller's Talk is a moderated listserv that provides members of the Billers’ Association for Long-Term Care exclusive access to a forum for networking, sharing ideas, and solving problems. Discussions center on best practices, suggestions, and other issues related to billing and revenue cycle management professionals. Ask a question, bounce ideas off of peers, or find out how others are improving their billing processes.

How it works: Billers’ Association members can post a message or question to the list 24 hours a day. Address messages that you want to send to the entire list to billers_talk@list.hcpro.com. The list moderator reviews each message during normal working hours and either addresses it directly or broadcasts the message to list members for their comments.

Question from your peers

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The Bottom Line

Q: We have a patient that was in the hospital for one week. The patient went to another skilled nursing facility (SNF) for 25 days, then went home, but used home health services. The patient now wants to come back into our SNF. It is within 30 days of the previous SNF stay, so this should be ok, but the SNF wants to know if the home health episode has any effect on the readmission?

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