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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Did you miss our most recent Billers’ Association for Long-Term Care webinar?

Jan 18, 2019
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The Bottom Line

Our speakers put on a great presentation this Wednesday with lots of helpful regulatory updates, including updates to the MDS, flu vaccination codes for 2019, and a walkthrough of how to use the new FISS/DDE search features. We also covered the SNF Value-Based Purchasing Program and how the new measures will affect facilities Medicare rates. If you missed the live show, you can listen to the recording here. Don’t forget to sign up for other webinars throughout the year on our webinar registration page

Chief compliance officer job description, competencies, and performance evaluation

Jan 18, 2019
 | 
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.

Don’t forget to register for next week’s webcast!

Jan 11, 2019
 | 
The Bottom Line

On Wednesday, January 16, 12:00pm – 1:00pm, ET, BALTC members are invited to join our quarterly webcast. The presentation will begin with a few membership update announcements from director of content, Brianna Shipley, followed by some important regulatory updates presented by HCPro’s post-acute regulatory specialist, Stefanie Corbett, DHA. Finally, BALTC advisory board member and senior consultant for LW Consulting, Jennifer Matoushek, MBA/HCM, CPC, will explain to listeners how the SNF Value-Based Purchasing Program can affect their Medicare rates, as well as an overview of what to expect from the program in 2019. After the presentation, audience members will be able to submit questions of our speakers.

Register here and don’t forget to pack a lunch!

Don’t let your HIPAA policies and procedures go stale

Jan 11, 2019
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Billing Alert for Long-Term Care

For HIPAA covered entities (CE) that maintain poor policies and procedures related to HIPAA compliance—those that are unfinished in draft form, not updated in years, and basically not followed to the letter—their lassitude has cost them dearly.

Just look at some of the settlements OCR has struck with CEs and business associates (BA) in the past five years. Many of those settlements include findings that organizations had poorly maintained policies and procedures. This has increased the settlement amounts and in turn led OCR to issue strict consent decrees requiring these entities to update and maintain their HIPAA-related policies and procedures.

What you need to know about the updated MDS items sets for 2019

Jan 11, 2019
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The Bottom Line

CMS posted a new DRAFT version of the 2019 MDS item sets (v1.17.0) last week. This version is scheduled to become effective October 1, 2019, giving facilities until then to update their software with the new MDS questions and answers. Downloadable files can be accessed here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html

HCPro’s post-acute regulatory specialist Stefanie Corbett, DHA, reports the following changes.

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.

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.

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.

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.

Providers have “affirmative duty” to check updated LEIE database

Dec 21, 2018
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The Bottom Line

Providers are encouraged to check the US Department of Health and Human Services, Office of Inspector General’s (OIG) updated List of Excluded Individuals and Entities (LEIE) database file to ensure that excluded individuals are not working in their facility, consequences of which could result in significant fines. The database was updated on December 10, 2018, and does not include individuals and entities that have been reinstated to the federal health care programs.

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