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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Payer sources for senior living, nine ways

Dec 14, 2018
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Billing Alert for Long-Term Care

Senior living (also referred to as assisted living) is a cash-reliant industry, often paid for by the residents themselves. In contrast to nursing homes or skilled nursing facilities, Medicare is not generally an option for senior living facilities because these companies do not address the skill level of nursing care facilities. Nevertheless, even though senior living care is technically less expensive than skilled nursing home care, it is far from being cheap. In 2016, the national average for assisted living was $3,628 per month. However, senior living care can vary considerably from approximately $3,000 to up to $8,000 each month. The variation in price is often reflective of geographic regions and the extent of offerings found in the senior living facility.

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.

New member resource for your compliance & ethics program

Dec 07, 2018
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The Bottom Line

As a result of updated survey protocols published in Appendix PP of the State Operations Manual on March 8, 2017, SNFs must have a compliance & ethics program in place by November 28, 2019. Implementing written policies and procedures is one element suggested by CMS to achieve a successful program, and having policies and procedures for the billing department is no exception. Download our Sample Policy for Reporting Overpayments to ensure that any known overpayment received by a federal healthcare program is appropriately refunded to avoid losing revenue dollars.

Submit your PDPM questions to CMS for December 11 call

Nov 30, 2018
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The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

Op ed: Are postacute, site-neutral payments the future?

Nov 20, 2018
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Billing Alert for Long-Term Care

Editor’s note: The following is reprinted with permission from a post on Reg’s Blog dated October 2, 2018, the senior and postacute healthcare news blog written by Reginald M. Hislop III.

In the 2019 OPPS (outpatient PPS) proposed rule, CMS included a site-neutral payment provision. With the comment period closed and the lobbying against such a provision fierce, it will be interesting to see where CMS lands in terms of the final OPPS rule: Will they maintain, change, or abate? The one thing that is for certain, regardless of the fate of this provision, is that site-neutral proposals/provisions are advancing.

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?

Providers worry that proposed rule could cut Medicaid revenue

Nov 09, 2018
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The Bottom Line

The CMS is drafting a proposed rule that would give states greater flexibility in paying (or not paying) for non-emergent medical transportation (NEMT) for Medicaid beneficiaries. This proposed rule aligns with CMS’ repeated intentions to create “a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population,” as stated in a letter from HHS secretary Tom Price and CMS administrator Seema Vera earlier this year.

Achieve accurate reimbursement and compliance with these best practices

Nov 09, 2018
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Billing Alert for Long-Term Care

A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. In any industry, best practices are developed over time. Professionals involved in the revenue cycle of a long-term care (LTC) facility must have a solid understanding of the fundamentals of claims processing as they relate to the Medicare regulations and the facility’s state Medicaid reimbursement system.

CMS final rule makes changes to how physicians are paid, delays E/M coding reform

Nov 02, 2018
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The Bottom Line

As part of a final rule published by CMS yesterday to reduce provider burnout, the implementation of coding reforms for physician services known as “Evaluation and Management” (E/M) visits--requirements that haven’t been updated in 20 years--were delayed until 2020 to allow for continued stakeholder engagement. For CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits and practitioners should continue to use either the 1995 or 1997 E/M documentation guidelines to document E/M office/outpatient visits billed to Medicare, according to a CMS fact sheet. Additional policies for CY2019 and beyond are listed in the fact sheet.

Reducing accounts receivable and improving collections: A success story

Nov 02, 2018
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Billing Alert for Long-Term Care

Deborah Collum, national director of revenue cycle management for Covenant Retirement Communities in Skokie, Illinois, uses one word to prepare people for how they’ll feel during their company’s first monthly accounts receivable (AR) meeting: naked.

“When my company first started conducting AR meetings, they were an hour and a half long, but now we’ve pared them down to about 20 minutes because our AR is so clean. You have to identify the ugly before you can get to the pretty,” she says.

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