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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Medicare managed care appeals and grievances

July 6, 2017
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The Bottom Line

Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare Advantage regulations.  For a detailed discussion of the Medicare managed care grievance and appeals processes, click here.

How to Employ Strategic Opportunities for Marketplace Differentiation

June 28, 2017
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Billing Alert for Long-Term Care

The challenge for skilled nursing facility (SNF) providers today is less about census and more about payer mix. Providers must develop a strong and replicable quality mix—one that, with the application of good marketing strategy and business development techniques, sources desired referrals consistently and dependably.

Part B Outpatient Therapy Q&A

June 21, 2017
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Billing Alert for Long-Term Care

Editorial note: This Q&A is excerpted from our soon-to-be published title, Medicare Guide for SNF Billing and Reimbursement by Janet Potter, CPA, MAS and Frosini Rubertino, RN, BSN, C-NE, CDONA/LTC.

Q: What are the circumstances that allow us to bill under Medicare Part B?

 A: When services are provided in a skilled nursing facility (SNF), Medicare Part B may be billable for residents who have exhausted their Part A benefits or are ineligible for benefit days under Part A, outpatient physical therapy (PT), outpatient occupational therapy (OT), and outpatient speech language pathology (SLP).  These therapy services are very common among SNF residents as they rehab from an acute condition such as a stroke or joint replacement.  Many SNF residents benefit from short or long term therapy services to help regain movement, strength and activities of daily living. Part B therapy claims are frequently subject to medical review and denial, making it important that the details are billed correctly and that documentation exists to support the services. 

Ensuring an Effective & Efficient Triple Check Process

May 19, 2017
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Billing Alert for Long-Term Care

he triple check process verifies claims for accuracy and compliance with Medicare regulations before billing. Since the Office of the Inspector General published a report that over a billion dollars of inappropriate payments were paid to skilled nursing facilities in 2009, many facilities have adopted the triple check process as a critical operational strategy to mitigate the risk of improper payments and triggering a Medicare audit.

Defining maintenance therapy: A proactive approach to quality care

May 5, 2017
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Billing Alert for Long-Term Care

In February 2017 a federal judge accepted Medicare’s plans to better educate the public about individuals’ eligibility for coverage of physical and occupational therapy and speech-language pathology services. These updated plans came as a result of the Jimmo Settlement, a solution to the lengthy class action originally filed in 2011 by six individual Medicare beneficiaries and seven national organizations against the Secretary of Health and Human Services.

Hospital Readmission Rates: Progressive Reductions

April 7, 2017
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Billing Alert for Long-Term Care

With prodding from federal officials and an industrywide shift toward delivering services based on value rather than volume, healthcare providers are making progress on reducing hospital readmission rates, federal statistics show. From 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries held steady at about 19% to 19.5%, according to the Centers for Medicare & Medicaid Services. But those rates fell to 18.5% in 2012 and 17.5% in 2013, CMS reports.

 

SNF merger and acquisitions: The provider number trap

March 24, 2017
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Billing Alert for Long-Term Care

Over my career, I have done a fair amount of merger and acquisition (M&A) work, including:

  • Continuing care retirement communities (CCRC)
  • Skilled nursing facilities (SNF)
  • Home health agencies (HHA)
  • Physician practices
  • Hospices

While each deal has many nuances and issues, none can be as confusing to navigate as the federal payer issues—specifically, the provider number. For SNFs, HHAs, and hospices, an acquisition that is not properly vetted and structured can have severe repercussions post-closing, if provider liabilities existed pre-close and were unknown and/or unknowable. Even the best due diligence cannot ferret out certain provider number–related liabilities.

The Medicare provider number is the unique reference number assigned to a participating provider. When initially originating as a provider, the organization must apply for provider status, await accreditation (for SNFs, this is done via a state survey; for HHAs and hospices, it is via private accreditation), and then get ultimate approval by Medicare/HHS. As long as the provider that has obtained the number remains in good standing with CMS—meaning it hasn’t had its provider status/agreement revoked—the provider may participate in, and bill, Medicare and Medicaid (as applicable).

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

March 10, 2017
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The Bottom Line

CMS has made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

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