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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Billing for surgical dressings

Feb 08, 2019
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Billing Alert for Long-Term Care

Surgical dressings are limited to primary dressings, which are therapeutic or protective coverings applied directly to wounds or lesions that are on the skin or are caused by an opening to the skin, and to secondary dressings that are therapeutic or protective (i.e., are needed to secure the primary dressing).

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.

Reminder to pharmacies for correctly billing Part B claims using KX modifier for immunosuppressive drugs

Jan 11, 2019
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The Bottom Line

In response to a 2017 OIG report noting that some pharmacies billed Medicare incorrectly for Part B claims using the KX modifier for immunosuppressive drugs, CMS has published several resources to clarify manual instructions and help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources include the following:

Special requirements for billing urology supplies & updated DMEPOS fee schedule

Dec 21, 2018
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The Bottom Line

Medicare covers urinary catheters and external urinary collection devices when they are used to drain or collect urine for a resident with permanent urinary incontinence or permanent urinary retention. According to CMS, permanent urinary retention occurs when the condition is not expected to be medically or surgically corrected within three months. The urology benefit under Medicare Part B does not cover the treatment of chronic urinary tract infection or other bladder conditions if the permanence requirement is not met.

GAO: New payment rates for Part B lab tests may lead to billions in overpayments

Dec 14, 2018
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The Bottom Line

Medicare’s new method of calculating payment rates for laboratory tests, intended to reduce Medicare spending by $360 million in the first year, could cost the agency billions in overpayments, according to a recent report from the U.S. Government Accountability Office

CMS established new payment rates for Medicare Part B laboratory services, effective in 2018. CMS was required under the Protecting Access to Medicare Act of 2014 (PAMA) to base the new rates on private payer data rather than on historical laboratory fees, which were typically higher than the rates paid by private payers. CMS is gradually phasing in reductions to Medicare payment rates, limited annually at 10% from 2018 to 2020, as outlined in PAMA.

Frequently asked questions about Medicare Part B

Nov 30, 2018
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The Bottom Line

Q: How should multiple units of the same HCPCS code given on the same day be listed on the UB-04 (e.g., four units of 97530 in occupational therapy)?

A: Units of the same HCPCS code provided by the same discipline on the same day should be listed on the same line item. In the above example, it would be one line with four units of 97530, and the individual unit charge would be multiplied by four.

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.

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.  

Billing for the flu vaccine

Oct 05, 2018
 | 
Billing Alert for Long-Term Care

As clinical teams work diligently to educate their residents about the flu, and offer and/or administer the influenza virus (or flu) vaccination to residents, the billing team should ensure that costs for the vaccination are captured and revenue is not left on the table for the billable service.

Medicare Part B pays 100% of flu vaccine costs, including costs associated with its administration. Part D benefits do not cover these costs. Payment is made on a cost basis for the vaccine and is based on the physician fee schedule for the administration. Deductibles and coinsurance do not apply to influenza, pneumococcal, or hepatitis B vaccines.

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