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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Take this 5-minute survey for a chance to win a webinar

Feb 15, 2019
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The Bottom Line

We’re conducting a brief survey to better understand your PDPM training needs. The first five participants who take the survey will receive a free, on-demand webinar of your choice. This is a quick survey and we greatly appreciate your feedback.

 Here's the URL to take the survey. Click the link or copy and paste it into your browser: https://www.surveymonkey.com/r/B53QM5G.

Please complete the survey before Monday, February 18 to be entered to win. Thank you!

Determining when to adjust or cancel a claim

Feb 08, 2019
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The Bottom Line

If a provider discovers a claim was paid incorrectly or in error, it is important that he or she takes the initiative to make a correction. Adjustment claims are also appropriate to add other charges to the claim, such as if an invoice for an ancillary item is received after the billing has been completed or was simply overlooked when the claim was prepared. Keeping Medicare funds that were improperly paid is considered Medicare fraud.

New mobile app allows consumers to see what Original Medicare covers

Feb 08, 2019
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The Bottom Line

Earlier this month CMS announced the release of a new app, “What’s Covered,” that allows people to quickly look up what Original Medicare covers using their mobile device. In addition to the “What’s Covered” app, CMS is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data through Blue Button 2.0.

New member resource: PDPM Ballpark Projections Questionnaire

Feb 01, 2019
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The Bottom Line

The PDPM Ballpark Projections Questionnaire created by HCPro’s postacute regulatory specialist Stefanie Corbett, DHA, allows SNFs to project what the minimum rate component for reimbursement will be under PDPM. The questionnaire lists important items to be considered during admission, such as “how many days does the resident have left in his/her benefit period?”

New white paper available: The role of ICD-10 in PDPM

Jan 25, 2019
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The Bottom Line

Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.

Read the full, members-only white paper.

What are SNF billers talking about this month?

Jan 18, 2019
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Billing Alert for Long-Term Care

The following Q&A comes from the Billers' Association for Long-Term Care talk forum, Biller's Talk.

Q: Is the facility required to give a Notice of Medicare Non-Coverage (NOMNC) to a benefit-exhausted resident?

A: An NOMNC is not required by CMS regulation to be issued in relation to benefit exhaust; however, it is not wrong or held against a facility to issue one at that time. Some organizations with multiple facilities require the NOMNC to be issued as a best practice and as part of their policy and procedures, even in the event that the Medicare Part A services are terminated due to benefit exhaust.

The regulations regarding NOMNCs can be found at CMS.gov in the Medicare Claims Processing Manual, Chapter 30, Section 260.

Triple check monthly billing review

Jan 11, 2019
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The Bottom Line

Implementing a triple check process in your facility not only helps improve therapy and nursing documentation, but can also assist in monitoring and identifying areas of discrepancy and opportunity to improve the management of the Medicare Part A process. Performing a monthly billing review can help ensure that critical elements are present on the MDS to ensure optimum payment. Download our triple check monthly billing review tool to keep each item organized and tracked.

‘Tis the season for SNF leaves of absence, are you prepared?

Dec 07, 2018
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Billing Alert for Long-Term Care

In preparing for the holiday festivities, it is essential for friends and family to understand that even if their loved ones are in a nursing home or skilled nursing facility (SNF), they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. Identifying the specific effects that a beneficiary’s leave of absence (LOA) can have on billing has long been hazy territory for SNFs, however, as they sometimes confuse Medicare’s consolidated billing (CB) requirements with internal definitions and policies they’ve developed for a beneficiary’s temporary exit from the facility.

Q&A from Biller’s Talk

Nov 20, 2018
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The Bottom Line

Q: This is my first time billing for the flu shots, can we add them to our Part A and Part B claims, or does it have to be a separate batch? Can you bill a roster through DDE?

A: Flu vaccines can only be reimbursed by Medicare Part B. They can be submitted via a roster or individual part b claims. You can bill a roster through DDE.

Featured questions from Biller’s Talk

Nov 16, 2018
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The Bottom Line

Q: A patient came in from the hospital. The patient was admitted to Medicare Part A and was expected to stay, however after two hours, she wanted to go home and the physician ordered home health services. The patient didn’t sign the contract at the time of admission and didn’t sign an advance beneficiary notice (ABN). Does this count as a utilization day and should Medicare be billed using the AAA default rate?

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