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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These 7 readmission risks could prevent you from receiving SNF VBP incentive payments

Nov 02, 2018
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The Bottom Line

As of October 1, 2018, the Skilled Nursing Facility (SNF) Value-Based Purchasing Program (VBP) rewards SNFs with incentive payments for reducing hospital readmissions. To receive incentive payments for this quality measure, make sure these 7 readmission risks don’t exist in your facility.

New white paper available

Oct 26, 2018
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The Bottom Line

Download The Billers’ Association fourth quarter white paper: An in-depth look at how reimbursement is calculated under PDPM. Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro breaks down tables and guidance from the final rule and PDPM calculation worksheet and provides a step-by-step guide to understanding the new payment model. Peruse this and previous year’s white papers on The Billers’ Association resources page. Have an idea for a topic you’d like to see? Write me at bshipley@hcpro.com.

CMS releases 2019 Medicare Parts A&B premiums and deductibles

Oct 19, 2018
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The Bottom Line

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs. Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  

MedPAC publishes resource for SNFs: Payment basics

Oct 19, 2018
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The Bottom Line

MedPAC released their Payment Basics for SNFs 2018 report, which provides an overview of Medicare coverage and reimbursement. You can download this resource from The Billers’ Association resource library. The report includes a map explaining how reimbursement is calculated under the current prospective payment system, Medicare daily base rates for FY19, and the RUG-IV classification system.

473 changes to ICD-10 codes

Oct 19, 2018
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Billing Alert for Long-Term Care

Coding tells the detailed story of your facility’s patient care, morbidity, and sometimes demographic information. ICD-10 coding in long-term care has several purposes, including to:

  • Collect diagnostic and statistical data
  • Support clinical decision-making
  • Verify medical necessity
  • Validate need for supportive procedures, treatments, and therapies
  • Support reimbursement for services provided
  • Determine RUG scores
  • Correctly code diseases on the MDS, UB-04, medical reports, therapy treatments, and ancillaries

CMS publishes 2016 SNF PUF data

Oct 12, 2018
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The Bottom Line

CMS has posted the fourth release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2016. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. 

Did you miss our quarterly webinar? Here’s how to listen.

Oct 12, 2018
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The Bottom Line

If you couldn’t attend the Billers’ Association for Long-Term Care’s quarterly webinar earlier this month, here’s what you missed! Click here to access the recording. Postacute regulatory specialist for HCPro, Stefanie Corbett, DHA, reviewed current regulatory updates and what they mean for SNF reimbursement, including the flu vaccine payment allowance and code updates, the latest changes to the MDS effective October 1, 2018, and a reminder of reporting requirements for the SNF QRP and VBP.

Are you billing Occurrence Code 22 correctly?

Oct 12, 2018
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The Bottom Line

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim.

Q&A: Getting to know PDPM

Sep 28, 2018
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Billing Alert for Long-Term Care

Q: When will the reimbursement rates begin decreasing?

A: After the 20th day of a resident’s stay, the PT/OT rate components will decrease by 2% every 7 days. The NTA rate component will be reduced after the third day of a resident’s stay by two-thirds of the initial NTA rate component amount.

Update to Medicare Claims Processing Manual, Chapter 23, Section 60.3

Sep 21, 2018
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The Bottom Line

For newly covered DMEPOS items paid on a fee schedule basis where a Medicare fee does not exist, the Centers for Medicare & Medicaid Services (CMS) uses a process to establish fees called gap filling. This allows Medicare to establish a price that aligns with the statutory requirements for the DMEPOS fee schedule.

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