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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Have you heard? We’ve added a NEW Administrator’s Bootcamp!

February 14, 2018
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The Bottom Line

The Long-Term Care Administrator’s Boot Camp offers skilled nursing facility administrators a review of Medicare regulations and best practices for ensuring the provision of high-quality services, resident satisfaction, quality survey outcomes, and proper payments. Specifically, The Long-Term Care Administrator’s Boot Camp focuses on how Medicare regulations guide clinical and financial operations, and explains the role of the administrator in admissions, documentation, MDS, billing, coding, compliance and ethics, and quality improvement.

Come join us!

New voluntary bundled payment model announced

January 12, 2018
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Billing Alert for Long-Term Care

On January 9, 2018, CMS’ Innovation Center announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced).  Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform.  Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

Achieve Up to $63K in Cost Savings

January 9, 2018
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The Bottom Line

SNF occupancy rates continue to trend downward. The National Investment Center for Senior Housing and Care reports a drop from 86% to 82% between 2012 and 2017—the lowest they’ve been in five years.

When facilities struggle with flat or declining census, their profitability often suffers. However, profitability for long-term and postacute care providers is not solely based on census and reimbursement. Facilities need to think outside the box to remain profitable during times of low or declining census and we want to show you how.

RCS-1: What's changing and how will you be affected?

December 22, 2017
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Billing Alert for Long-Term Care

Skilled nursing facility (SNF) providers are on the edge of their seats as they anticipate the Centers for Medicare and Medicare Services' (CMS) consideration of a replacement for the Resource Utilization Group (RUG) system to change the pay for SNF Medicare Part A residents beginning FY2019. The Resident Classification System, Version 1 (RCS-1), will be the most significant change in the current reimbursement model, which has been in place for nearly two decades. Since being published in the Federal Register on April 27, 2017, providers and advocacy groups have submitted public comments and recommendations on the SNF prospective payment system (PPS) payment methodology proposed in the Summary of Advance Notice. Many concerns have been raised, especially regarding the reimbursement methodology for therapy services.

Low Volume Appeals Settlement Option Call

December 20, 2017
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The Bottom Line

Dial in on Tuesday, January 9 from 1:30 to 2:30 pm EST to hear about the settlement option for providers with fewer than 500 appeals pending at the OMHA and the Council at the Departmental Appeals Board.

As part of the broader HHS commitment to improving the Medicare appeals process, CMS will make available a settlement option for providers and suppliers (appellants) with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals (OMHA) and the Medicare Appeals Council (the Council) at the Departmental Appeals Board.

Bundled payments on hiatus?

October 27, 2017
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Billing Alert for Long-Term Care

Or, could this be the beginning of the end for bundled payments?

Within the last few days, CMS/HHS sent a proposed rule to the Office of Management and Budget (OMB) that would cancel the planned January 2018 rollout of the (mandatory) cardiac and traumatic joint repair/replacement bundles. Specifically, CMS was adding bypass and myocardial infarction DRGs to the BPCI (Bundled Payments for Care Improvement) along with DRGs pertaining to traumatic upper-femur fracture and related joint repair/replacement. The original implementation date was March, then delayed to May and again delayed to October; it now stands at January 2018. Additionally, the proposed rule includes refinement proposals for the current mandatory CJR bundles (elective hip and knee replacements). It is widely suspected that the mandatory nature of the CJR will revert to a voluntary program in 2018.

In long-term care credentialing, be rigorous yet realistic

October 20, 2017
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Billing Alert for Long-Term Care

In many nontraditional environments, the rise of credentialing is outstripping the development of regulatory and accreditation standards, leaving organizations with scant guidance on how to foster consistency across their spectrum of services and align their vetting practices with setting-specific needs. 

The long-term care industry is a prime example of this incongruity. Because broad-based vetting standards for nursing homes are few and far between, practices can vary depending on a facility’s size, financial position (e.g., for profit, not-for-profit), affiliation (e.g., independent, hospital-based, member of a health system), and scope of service delivery. “It’s kind of all over the place,” says Susan M. Levy, MD, CMD, a nursing home medical director in Delaware and the immediate-past president of AMDA—The Society for Post-Acute and Long-Term Care Medicine. 

FAQs: Consolidated billing for SNFs

October 13, 2017
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Billing Alert for Long-Term Care

Since its introduction in the skilled nursing facility (SNF) setting, consolidated billing (CB) has been one of the most routine yet misunderstood methods for SNFs to secure Medicare reimbursement.

To better grasp the complex principles, regulations, and systems that surround consolidated billing, SNFs must first have a solid foundation in Medicare Part A coverage and criteria. Without a basic understanding of this powerful insurance plan, SNFs risk committing or contributing to a number of punishable payment offenses, including improper billing, over- and underpayments, fraud, and abuse-related Medicare infractions that can carry serious ramifications, including steep penalties, exclusion from the program, imprisonment, or any combination thereof. 

 

The below Q&A contains questions that have been transcribed from our live webinar show, “Consolidated Billing for SNFs: A Close Look at the Five Major Categories,” hosted by expert speaker Janet Potter, CPA, MAS, senior manager, advisory services for Marcum LLP, and from frequently asked questions included in Potter’s new book, Medicare Guide for SNF Billing and Reimbursement. For more information on CB for SNFs, listen to the on-demand show or purchase our newly released Medicare billing guide.

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