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.

Become a Member Sample Content

2019 Revenue Integrity Symposium call for speakers—deadline extended through March 1

Feb 15, 2019
 | 
The Bottom Line

NAHRI is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. We seek speakers to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. NAHRI will waive admission fees to the 2019 Revenue Integrity Symposium for all selected speakers and co-speakers. Click here to learn more and complete the call for speakers application. Contact NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com with questions.

Navigating tax reform in 2019

Feb 01, 2019
 | 
Billing Alert for Long-Term Care

After speaking with a few subject matter experts about the new tax laws, Billing Alert for Long-Term Care has the good, the bad, and the salvageable for 2019 tax reform. For some long-term care (LTC) facilities, these changes will have significant dollar impacts on 2018 tax returns, while other facilities will slip through the IRS’ narrow cracks mostly unaffected. Just as the care plan for each resident should be individualized to his or her care needs, each facility’s approach to taxes this year should be customized to its unique situation. Here are a few changes to keep in mind and discuss with your certified public accountant (CPA) before submitting this year’s tax return.

CMS update changes requirements for functional reporting

Feb 01, 2019
 | 
The Bottom Line

CMS announced an update on therapy caps and functional reporting in an MLN Matters article dated January 25, 2019. Effective for dates of service on or after January 1, 2018, providers of therapy services shall continue to report the KX modifier on claims as applicable. The modifier no longer represents an exception request but serves as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record after the beneficiary has exceeded the threshold of incurred expenses

New white paper available: The role of ICD-10 in PDPM

Jan 25, 2019
 | 
The Bottom Line

Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.

Read the full, members-only white paper.

What are SNF billers talking about this month?

Jan 18, 2019
 | 
Billing Alert for Long-Term Care

The following Q&A comes from the Billers' Association for Long-Term Care talk forum, Biller's Talk.

Q: Is the facility required to give a Notice of Medicare Non-Coverage (NOMNC) to a benefit-exhausted resident?

A: An NOMNC is not required by CMS regulation to be issued in relation to benefit exhaust; however, it is not wrong or held against a facility to issue one at that time. Some organizations with multiple facilities require the NOMNC to be issued as a best practice and as part of their policy and procedures, even in the event that the Medicare Part A services are terminated due to benefit exhaust.

The regulations regarding NOMNCs can be found at CMS.gov in the Medicare Claims Processing Manual, Chapter 30, Section 260.

Words on the street: Acronyms of PDPM

Jan 04, 2019
 | 
Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

Implementing an efficient preadmission screening process to determine potential revenue under PDPM

Jan 04, 2019
 | 
The Bottom Line

Most hospitals like for facilities to respond to referrals within 15 minutes, and that can be a very ambitious goal. It usually includes running insurance, speaking with the director of nursing, or calling the pharmacy to get an idea of drug costs. Facilities are used to relying on their admissions coordinator to conduct many of these tasks, but under the Patient Driven Payment Model (PDPM), providers will have to involve more team members in the preadmission screening process.

Key elements of ACO program overhaul

Dec 27, 2018
 | 
The Bottom Line

CMS finalized a rule with new requirements for accountable care organizations (ACO) last week, reducing the amount of time an ACO is allowed to stay in the program without assuming risk and expanding the three-day stay waivers for nursing homes. “Most Medicare ACOs do not currently face financial consequences when costs increase, but a review of the data on ACO performance shows that over time those ACOs that take accountability for costs perform better than those that do not,” said CMS administrator Seema Verma in a blog post dated December 21, 2018.

Pages

Free Resources

Access sample white papers, tools, analysis, and resources.