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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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.

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.

Biller's Talk Q&A: Questions, concerns, and solutions from your peers

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Billing Alert for Long-Term Care

What it is: Biller's Talk is a moderated listserv that provides members of the Billers’ Association for Long-Term Care exclusive access to a forum for networking, sharing ideas, and solving problems. Discussions center on best practices, suggestions, and other issues related to billing and revenue cycle management professionals. Ask a question, bounce ideas off of peers, or find out how others are improving their billing processes.

How it works: Billers’ Association members can post a message or question to the list 24 hours a day. Address messages that you want to send to the entire list to billers_talk@list.hcpro.com. The list moderator reviews each message during normal working hours and either addresses it directly or broadcasts the message to list members for their comments.

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.

Question from your peers

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The Bottom Line

Q: We have a patient that was in the hospital for one week. The patient went to another skilled nursing facility (SNF) for 25 days, then went home, but used home health services. The patient now wants to come back into our SNF. It is within 30 days of the previous SNF stay, so this should be ok, but the SNF wants to know if the home health episode has any effect on the readmission?

What are the experts saying about PDPM?

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The Bottom Line

If you’ve been paying attention to the progression of CMS’ new payment system to replace RUG-IV, beginning with the advanced notice of proposed rule-making published last April, when it was introduced as the Resident-Classification System, to the proposed rule published this May, when it was revamped and renamed the Patient-Drive Payment Model (PDPM), the good news is that the biggest change is behind us. The SNF PPS final rule released by CMS this week doesn’t deviate too much from the proposed rule, but as experts get a chance to read through the 424-page document, they have a mix of concerns, words of advice, and positive outlooks for change.

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