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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The essential role of MDS 3.0 in RCS-1

October 6, 2017
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Billing Alert for Long-Term Care

Currently, Medicare pays for services provided by skilled nursing facilities (SNF) under the Medicare Part A SNF PPS benefit on a per diem basis using the RUG-IV grouper. The most significant driver of this reimbursement model is the amount of therapy (days and minutes) provided to a Medicare resident, regardless of outcomes achieved. Through the years, many providers, government entities, and advocacy groups alike have voiced concerns over inappropriate incentives in this current reimbursement model. Caregivers of all types complained about a system that “de-incentivizes” an individualized approach to therapy treatment. Nurses felt their residents’ care was usurped by a system that didn’t consider their overarching needs. Not surprisingly, this led to overutilization; CMS estimates that in 2016, 11% of Medicare fee-for-service (FFS) dollars were paid incorrectly ($41.1 billion), with $2.8 billion of that amount being paid to SNFs for services almost entirely related to therapy.

Don’t forget the business office

September 29, 2017
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The Bottom Line

One of the most important staff members in the facility is the person who informs the family that they owe money. The family will have a lasting relationship with the business office for a multitude of reasons; it is essential that they get off to a good start by introducing the business office manager and understanding the billing and financial obligations.

CMS to grant exceptions to providers affected by Hurricane Irma

September 15, 2017
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The Bottom Line

CMS is granting exceptions under certain Medicare quality reporting and value-based purchasing programs to acute care hospitals, PPS-exempt cancer hospitals, inpatient psychiatric facilities, skilled nursing facilities, home health agencies, hospices, inpatient rehabilitation facilities, renal dialysis facilities, long-term care hospitals, and ambulatory surgical centers located in areas affected by Hurricane Irma due to the devastating impact of the storm.

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.

CMS Special Open Door Forum: The IMPACT Act and Improving Care Coordination

September 8, 2017
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The Bottom Line

This Special Open Door Forum (SODF) will provide information and solicit feedback pertaining to the Improving Medicare Post-Acute Care Transformation Act of 2014 (commonly referred to as the IMPACT Act). This SODF will focus on the goals of the IMPACT Act, update attendees on the RAND contract activities for item development, including pilot test results and plans for the upcoming national field test, and identify opportunities for providers, consumers, stakeholders, researchers, and advocates to become involved over the next year.

$370 million increase for SNFs raises more than just pay rates

September 1, 2017
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Billing Alert for Long-Term Care

It’s been said that Rome wasn’t built in a day, which is an archaic way of saying: Be patient, good things are coming. As the Centers for Medicare & Medicaid Services (CMS) navigate what some may consider to be healthcare’s own modern-day Roman empire¾a system undergoing serious revisions including how levels of care are monitored, the way reimbursement is divided, and the anything-but-straight-and-narrow shift from volume to value¾SNF providers are participating in history being made. On Monday, July 31, with the publication of a multi-faceted final rule, Rome’s grand plans just got a little grander¾but experts wonder if its tight budget will be enough to cover renovations. 

SNF reimbursement cuts are less than three months away

July 26, 2017
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The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) released a memo alerting nursing homes that reimbursement cuts are less than three months away for any SNF that does not submit required quality data. Beginning with FY 2018 (October 1), and each subsequent year, if a SNF does not submit required quality data, their payment rates for the year are reduced by 2 percentage points for that fiscal year.

CBO predicts 32 million will be without health coverage in 2026 with new repeal-and-delay bill

July 20, 2017
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After the Senate’s recommendation for repeal-and-replace of the Affordable Care Act (ACA) failed due to lack of support, Majority Leader Mitch McConnell is now suggesting a repeal-and-delay strategy that, if passed, is predicted will leave 32 million individuals without health coverage by 2026, and 17 million without coverage by next year. That’s 1 million more than were predicted to be without coverage under the initial repeal-and-replace tactic.

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