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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Survey preparation: How self-audit practices come from QAPI

September 15, 2017
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Billing Alert for Long-Term Care

To help prepare for survey readiness, it is crucial that you regularly audit your facility practices. Many audits can be scheduled routinely, but in all cases, these audits should be performed no later than when the survey window begins. These self-audits help create the survey readiness mode for staff, as auditing creates potential opportunities for improvement through the Quality Assurance and Process Improvement (QAPI) program (determining root causes with Plan of Correction implementation). In fact, the primary source of identification of audits required often comes out of the QA/QAPI program.

Not your mama’s PBJ

September 8, 2017
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Billing Alert for Long-Term Care

Since its initial inception as part of Section 6106 of the Affordable Care Act, the payroll-based journal (PBJ) requirement, which took effect July 1, 2017, has caused long-term care providers several growing pains as the CMS reporting mandate competes with facilities’ many other priorities. Prior to its implementation, in October 2015 CMS launched a voluntary phase of the PBJ reporting system, allowing providers to test their submission process. Few providers participated in the trial run, however, possibly because they were uncertain where their information would end up—or because they were hoping the government program would be postponed.

How to Employ Strategic Opportunities for Marketplace Differentiation

July 26, 2017
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Billing Alert for Long-Term Care

The challenge for skilled nursing facility (SNF) providers today is less about census and more about payer mix.

Providers must develop a strong and replicable quality mix—one that, with the application of good marketing strategy and business development techniques, sources desired referrals consistently and dependably. In this manner, the SNF achieves occupancy and revenue targets consistent with its business or strategic plan. From a business development perspective, the strategy and thus the results are organic—naturally occurring as a result of operational standards and care outcomes.

New Medicare Compliance and Ethics Program Requirements

July 12, 2017
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Billing Alert for Long-Term Care

CMS published the Final Rule to Reform Requirements for Long Term Care Facilities on October 4, 2016, with an effective date of November 28, 2016. Survey protocols and interpretive guidelines were published on March 8, 2017, in Appendix PP of the State Operations Manual. One of the new requirements for nursing facilities is to implement a compliance and ethics program in the last phase of the timetable for changes. Due to the time and resources needed to achieve compliance with the new requirements, surveyors will not begin surveying for compliance with this change until November 28, 2019.

Medicare managed care appeals and grievances

July 6, 2017
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The Bottom Line

Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare Advantage regulations.  For a detailed discussion of the Medicare managed care grievance and appeals processes, click here.

Triple Check Q&A with Stefanie Corbett, DHA

May 23, 2017
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Billing Alert for Long-Term Care

Did you know? The Billers’ Association for Long-Term Care hold quarterly webinars free of charge for members! Every quarter, listen as Stefanie Corbett, DHA, postacute regulatory specialist at HCPro breaks down regulatory changes, unpacks complex ideas, and explains how to increase accuracy for optimal reimbursement. Following each webinar’s presentation, there is a live Q&A so you can ask questions of our speaker.

Ensuring an Effective & Efficient Triple Check Process

May 19, 2017
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Billing Alert for Long-Term Care

he triple check process verifies claims for accuracy and compliance with Medicare regulations before billing. Since the Office of the Inspector General published a report that over a billion dollars of inappropriate payments were paid to skilled nursing facilities in 2009, many facilities have adopted the triple check process as a critical operational strategy to mitigate the risk of improper payments and triggering a Medicare audit.

IMPACT Act, VBP, care coordination, and the SNF landscape

April 28, 2017
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Billing Alert for Long-Term Care

Now that we’re into the first quarter of the year, it is time to take stock of the postacute/SNF landscape, particularly as it pertains to evolutionary policy initiatives now and in the future. To start, there is little evidence on the horizon of an all-out retreat on the policy changes begat by the Affordable Care Act (ACA, or Obamacare). While some framework is building to "repeal and replace" the ACA, that framework will leave fundamentally intact the changes wrought by bundled payments, value-based purchasing, and the IMPACT Act. The Republican majority, a smattering of Democrats, and the incoming secretary of HHS have signaled support for these initiatives. Should a repeal strategy move forward any time soon, they will likely remain, whether fleshed or skeletal.

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