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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Case studies and scenarios: Various types of audits

June 29, 2018
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Billing Alert for Long-Term Care

Most audits are conducted in very similar manners. They also determine their focus using very similar techniques. Recovery Audit Contractors (RAC) are announcing their focus for complex reviews on their websites. The main difference between them is what they are specifically looking for. These examples are taken from various real-life scenarios and potential scenarios.

New Medicare cards: What’s that square code?

June 22, 2018
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The Bottom Line

CMS published an announcement explaining that some of the new Medicare cards may have a square code, also referred to as a QR code (a type of machine-readable code).

“The QR codes on Medicare cards allow the contractor who prints the cards to ensure the right card goes to the right person with Medicare or Railroad Retirement Board (RRB) benefits. Providers cannot use it for any other purpose. The RRB issued cards may have a QR code on the front of the card while all other Medicare patients may get a new card with a QR code on the back of the cards. These are legitimate (official) Medicare cards,” says the announcement.

What are you doing in August?

June 8, 2018
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The Bottom Line

Join us in Chicago on Monday and Tuesday, August 13-14, to attend our SNF Regulatory Update Boot Camp! This event covers the industry changes that impact your clinical and financial operations while providing strategies for achieving and sustaining compliance in the future marketplace. Attendees can expect to learn best practices for leading and managing facilities to avoid survey issues, claims audits, and improper Medicare payments.

New proposed payment system, part I: Case-mix components drill-down

June 8, 2018
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Billing Alert for Long-Term Care

With the release of the proposed rule on April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) introduced the Patient-Driven Payment Model (PDPM) with a proposed implementation date of October 1, 2019. This model is intended to replace the current prospective payment system reimbursement structure, Resource Utilization Groups, Version IV (RUG-IV), and significantly revises the Resident Classification System, Version I (RCS-I), which was introduced to the industry as a proposed RUG-IV replacement in an Advanced Notice of Proposed Rule Making (ANPRM) in 2017. RCS-I and PDPM were developed in conjunction with Acumen, a consulting group hired by CMS, and an interdisciplinary technical expert panel.

Proposed payment rule PDPM: What SNFs need to know

June 1, 2018
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The Bottom Line

The Patient-Driven Payment Model (PDPM), as proposed, is designed to replace the current SNF payment methodology known as RUG-IV. Unless date changes, etc. are made by CMS post commentary review, the effective date of the change (from resource utilization groups to PDPM) is October 1, 2019. PDPM as an outgrowth of the initially proposed resident classification system (RCS) and received commentary is a simplified payment model designed to be more holistic in patient assessment, capture more clinical complexity, eliminate or greatly reduce the therapy focus by eliminating the minute levels for categorization, and simplifying the assessment process and schedule (reducing to three possible assessments/MDS tasks). Below is a summary of PDPM core attributes/features as proposed. Click here to access the PDPM Calculation Worksheet for SNFs that provides additional details beyond the reference points below.

Providers encouraged to review eligibility requirements for expanded dispute resolution process

May 31, 2018
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The Bottom Line

Earlier this month CMS explained an expansion of the Office of Medicare Hearings and Appeals’ (OMHA) Settlement Conference Facilitation (SCF) program. SCF is an alternative dispute resolution process at OMHA that gives certain providers and suppliers an opportunity to resolve their eligible Part A and Part B appeals. The goal of this expansion is to reach additional providers and suppliers. HHS encourages all Medicare Part A and Medicare Part B providers and suppliers who have OMHA or Medicare Appeals Council appeals pending to familiarize themselves with the eligibility requirements for SCF.

New Medicare card mailing update

May 31, 2018
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The Bottom Line

CMS has started mailing new Medicare cards to people with Medicare who live in Wave 2 states and territories: Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, and Oregon. CMS continues to mail new cards to people who live in Wave 1 states, as well as nationwide to people who are new to Medicare.

Q&A: Post-Medicare audit processes

May 18, 2018
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Billing Alert for Long-Term Care

Q: What should we do if we feel that the auditor’s findings are blatantly wrong?

A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.

Patient-driven payment model, survey, and quality: Understanding MDS accuracy and what you need for success

May 11, 2018
 | 
Billing Alert for Long-Term Care

On Friday, April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published a highly anticipated proposed rule containing a recommendation to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV). The proposed model, Patient-Driven Payment Model (PDPM), significantly revises the Resident Classification System, Version I (RCS-I), which was introduced as a potential RUG-IV replacement last April in an Advanced Notice of Proposed Rulemaking.

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