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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Chief compliance officer job description, competencies, and performance evaluation

Jan 18, 2019
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The Bottom Line

By now, most organizations have identified a compliance officer, set up a reporting hotline for staff to report concerns, and done some training with staff on the elements of their facility’s specific compliance and ethics plan to meet the November 28, 2019 implementation deadline.

Having a trusted and responsible person that reports directly to the governing board is imperative to the success of a compliance and ethics program. The compliance officer is responsible for overseeing all aspects of the implementation of the program and reporting its progress on a regular basis to senior management. This individual is also primarily responsible for evaluating the program’s needs and tailoring the tools required of a compliance and ethics program to best meet those in a timely manner. Download our Chief Compliance Officer Job Description, Competencies, and Performance Evaluation to help this role measure his or her success.

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

Jan 04, 2019
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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.

Featured member resource: The preadmission checklist

Jan 04, 2019
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The Bottom Line

The Medicare meeting is a staple of a facility’s ability to coordinate care and capture reimbursement for their Medicare beneficiaries. The frequency with which this meeting occurs may depend on your Medicare census and the effectiveness of your meetings. In order for collaboration to be successful, it is considered best practice to have several meetings to regularly discuss residents’ care plans and preferred outcomes prior to billing a Medicare claim. These meetings may include preadmission daily reviews to discuss any resident who may be admitted to the facility. A preadmission checklist can help a facility prepare for the new resident and also begin discussions regarding that resident’s discharge plans. Download our sample checklist.

Policy and procedure to help prevent costly medication discrepancies

Dec 27, 2018
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The Bottom Line

The long-term care environment is one of the most complicated and challenging clinical settings in all of medicine, placing residents who reside in a nursing home or SNF at substantial risk of adverse outcomes related to medication use. At any point in time, there are approximately 1.5 million people living in 15,000+ nursing homes across the country, with around 2.8 million having a skilled nursing facility (SNF) stay at some point throughout the year. With the complex, heavily regulated nursing home admission process and the lack of any standardized drug regimen review (DRR) process, there are many opportunities for medication errors or potentially clinically significant medication issues (PCSMI) to occur.

Key elements of ACO program overhaul

Dec 27, 2018
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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.

Four CASPER reports you should be paying attention to

Dec 27, 2018
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Billing Alert for Long-Term Care

The Certification and Survey Provider Enhancement Reports (CASPER) quality measures (QM) reports should be used to identify areas of opportunity for improving quality of care. State surveyors and facilities may access each of the reports online in the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing system, where Minimum Data Set (MDS) data are normally transmitted. The site can be found at www.qtso.com/providers/cmsnet-submission-access. The reports are generated through the Centers for Medicare & Medicaid (CMS) CASPER reporting system. It is important for facilities to become familiar with CASPER QM reports, because surveyors review the data in these reports to assess the quality of the facility’s care to residents.

Q&A: Reducing readmissions to meet SNF VBP requirements

Dec 21, 2018
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Billing Alert for Long-Term Care

Q: A patient is discharged from the skilled nursing facility (SNF) on day 24 and sent home to receive home health services. The patient falls at home on day 28 and is admitted to the hospital due to a fractured hip. Does this count as a readmission under the SNF value-based purchasing (VBP) program?

A: Yes. It doesn’t matter where the patient was post-discharge. If the patient was within that 30-day window from the original hospital stay through the SNF discharge, any rehospitalization is fundamentally tagged to the SNF, and then the question becomes whether it was avoidable. In this case, a hip fracture would more than likely be determined avoidable.

Civil monetary penalties to fund new CMS quality improvement initiative

Nov 30, 2018
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The Bottom Line

CMS announced a three-year quality improvement initiative in a press release on November 20, 2018. The Civil Money Penalty Reinvestment Program (CMPRP) aims to improve residents’ quality of life by equipping nursing home staff, administrators, and stakeholders with technical tools and assistance to enhance resident care. The CMPRP is funded by federal civil money penalties, which are fines nursing homes must pay CMS by law when they are noncompliant with certain regulations and there are serious concerns about the safety and quality of care they provide.

Healthcare winners and losers from election night 2018

Nov 09, 2018
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The Bottom Line

Source: HealthLeaders

The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them. The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate. Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.

Featured member resource: MDS chart audit tool

Nov 09, 2018
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The Bottom Line

The purpose of the MDS chart audit tool is to ensure documentation is present in the medical record to support the findings of the MDS. Use the tool at the end of the month or the episode of care. If documentation that supports the MDS is present for each item, place a checkmark. If it is not, highlight the area so it can be followed up on to ensure completeness. This form can be completed by the MDS coordinator, DON, medical records, therapy director, or delegated per area of specialty. Download this Billers’ Association for LTC member resource.

 

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