Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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Billers’ Association members, have you signed up for our quarterly webinar?

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The Bottom Line

Join us on Wednesday, October 3, 1-2pm, ET for our quarterly Billers’ Association for Long-Term Care webinar. We’ll open the show with some exciting new member updates and hear about the latest regulatory updates from post-acute care regulatory specialist Stefanie Corbett, DHA. Following Stefanie’s presentation we’ll welcome a member from our association’s advisory board, industry expert Maureen McCarthy, RN, BS RAC-MT, QCP-MT, DNS-CT, who will review PDPM and what billers should be doing now to prepare. The show will end with a live Q&A session, so come prepared to ask!

CMS releases updates to billing for flu vaccine

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The Bottom Line

Flu season is August to April. Make sure you’re prepared to start billing for the influenza virus vaccine by staying up to date on the latest code and payment allowance updates. So far, CMS has released the following two notices: 1. Payment allowances for the influenza virus vaccine are updated on August 1 each year. This year’s annual update has been released, according to a CMS MLN Matters article. Click here for 2018-2019 payment allowances and effective dates.

SNF final rule: Prepare for PDPM

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The Bottom Line

CMS’ final rule, effective in October 2019, is a major overhaul for the long-term care industry, including SNFs. To survive, stakeholders must understand how reimbursement will work and how their facilities will need to function. Join expert speaker Stefanie Corbett, DHA, on Wednesday, October 24, 1:00-2:00pm, ET, for this 60-minute webinar. Learn what you need to know about the new case-mix groupings, how therapy is affected, and what SNFs need to do to remain viable in this new landscape.

Seven tips for reviewing and responding to PEPPER reports

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The Bottom Line

Every April, CMS makes the Program for Evaluating Payment Patterns Electronic Report (PEPPER) available for SNFs. The agency offers variant reports for a number of other Part A provider types, including hospitals, home health agencies, and hospices. These tools, which provide comparative billing data across a handful of setting-specific risk areas, can play an important part in a provider’s corporate compliance and ethics program. To get the most out of the report, SNFs should have a strategy in place for integrating its findings into their corporate compliance and ethics program before accessing this year’s edition. 

Calculating reimbursement under PDPM

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Billing Alert for Long-Term Care

Many staff members in a skilled nursing facility (SNF) have contributed to the minimum data set (MDS) under the current SNF prospective payment system, but few are able to explain how that documentation converts to a dollar amount or understand how the Centers for Medicare & Medicaid Services (CMS) defines a RUG rate. To help providers prepare for the transition from RUG-IV to CMS’ new Patient Driven Payment Model (PDPM), a calculation worksheet has been made available so staff will be able to explain how care services translate into reimbursement rates by the new payment model’s implementation date, October 1, 2019.

Combing patient records for additional diagnosis codes reaps massive returns for Medicare Advantage plans

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The Bottom Line

Under traditional Medicare in a SNF, diagnosis codes don’t have a significant impact on reimbursement. Medicare Advantage plans, however, contain a built in incentive that encourages providers to code all diagnoses possible in order to receive optimal payment, which in recent cases has led to retrospective chart review of patients’ medical charts to identify additional diagnosis codes for submission to CMS.

10 things you need to know about CMS’ final SNF PPS rule, and PDPM

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Billing Alert for Long-Term Care

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register dated August 8, 2018, the Patient-Driven Payment Model (PDPM)--the new case-mix methodology to replace RUG-IV--is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. The final rule also establishes a 2.4% market basket update, meaning an $820 million raise for SNFs beginning October 1, 2018.

[WEBINAR] Consolidated billing: How new payment reform affects SNFs

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The Bottom Line

The final payment rule for SNFs is here. Under the Patient-Driven Payment Model (PDPM), SNFs can expect greater reimbursement for residents with more clinical complexity, higher acuity, and multiple comorbidities. It will be critical for facilities to understand SNF consolidated billing to properly anticipate the projected revenue and costs of care with the advent of this new model.

CMS makes several Medicaid announcements, including new audits and requirement for budget neutral demos

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The Bottom Line

In a statement made my CMS administrator Seema Verma dated August 21, 2018, it was announced that CMS will begin auditing some states’ managed care organization financial reporting based on the amount spent on clinical services and quality improvement versus administration and profit. Verma’s statement was made before the U.S. Senate Committee on Homeland Security and Governmental Affairs Committee in order to explain CMS’ efforts to improve the integrity of the Medicaid program following the GAO’s June 2018 findings and recommendations for addressing growth in overall Medicaid spending.

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