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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Interactive tutorial for completing the ABN now available

May 24, 2018
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The Bottom Line

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, should be used by skilled nursing facilities (SNF) in relation to Medicare Part B services notification of noncoverage. The ABN allows fee-for-service beneficiaries to make an informed decision about whether to get the item or service that may not be covered and accept financial responsibility if Medicare does not pay. If the beneficiary does not get written notice when it is required, he or she may not be held financially liable if Medicare denies payment, and the provider or supplier may be financially liable if Medicare does not pay.

New white paper: Using collaboration to achieve accurate diagnoses claims

May 24, 2018
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The Bottom Line

The American Health Information Management Association’s definition of principal/first diagnosis lists the primary reason for the encounter as determined at the end of the encounter. In the LTC setting, it is referred to as the first listed code, described as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” The primary diagnosis, or the first listed code, is assigned after reviewing the resident’s hospital admission and discharge documentation. In some cases, the primary diagnosis code may apply at the hospital as well as the SNF, but this is not always so.

Medicare’s prior authorization program may continue under GAO recommendation

May 23, 2018
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The Bottom Line

Beginning in 2012, CMS introduced prior authorization to the Medicare program, which requires beneficiaries to obtain approval before receiving certain services or items, such as powered wheelchairs. A $1.9 billion reduction in Medicare spending on items requiring prior authorization has resulted, proving success in CMS’ initiative to reduce improper payments and expenses.

Medicare to pay more for DME services

May 18, 2018
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The Bottom Line

On May 11, CMS published an Interim Final Rule with Comment Period in the Federal Register regarding adjustments to the Durable Medical Equipment (DME) Fee Schedule. The rule increases fee schedule rates for certain DME items and services as well as enteral nutrition furnished in rural and non-contiguous areas of the country not subject to the DMEPOS Competitive Bidding Program (CBP).

Q&A: Post-Medicare audit processes

May 18, 2018
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Billing Alert for Long-Term Care

Q: What should we do if we feel that the auditor’s findings are blatantly wrong?

A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.

Increase revenue savings by eliminating this common error

May 18, 2018
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The Bottom Line

Effective October 1, 2018, drug regimen review (DRR) will be a quality measure in the SNF Quality Reporting Program (QRP) created to assess whether providers are proactive in identifying and reconciling potential clinically significant medication issues. It’s essential that long-term care nursing staff understand the DRR process, as well as CMS’ expectations for the new requirement, in order to avoid citations and increase quality and revenue savings.

President “will keep turning up the pressure” until pharmaceutical industry puts patients first

May 17, 2018
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The Bottom Line

During remarks on President Trump’s drug pricing blueprint held in Washington, D.C. earlier this week, Secretary of Health and Human Services (HHS) Alex Azar II talked about patients who have been “let down by all the players in our drug pricing system” as a result of high prescription drug prices. To fix this problem, HHS is putting forth a proposed set of changes that Azar referred to as “more sweeping than any drug-pricing initiative ever,” and “more bold than any set of proposals set forth before.”

Patient-driven payment model, survey, and quality: Understanding MDS accuracy and what you need for success

May 11, 2018
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Billing Alert for Long-Term Care

On Friday, April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published a highly anticipated proposed rule containing a recommendation to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV). The proposed model, Patient-Driven Payment Model (PDPM), significantly revises the Resident Classification System, Version I (RCS-I), which was introduced as a potential RUG-IV replacement last April in an Advanced Notice of Proposed Rulemaking.

CMS call to clarify qualified Medicare beneficiary (QMB) program billing requirements

May 10, 2018
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The Bottom Line

On Wednesday, June 6, from 1:30 to 3:00 pm ET CMS experts will discuss the QMB billing requirements and their implications. The call will also discuss the July 2018 re-launch of changes to the remittance advice and November 2017 changes to the HIPAA Eligibility Transaction System (HETS) to identify the QMB status of a facility’s patients and exemption from cost-sharing.

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