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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2019 Revenue Integrity Symposium call for speakers—deadline extended through March 1

Feb 15, 2019
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The Bottom Line

NAHRI is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. We seek speakers to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute care and long-term care settings. NAHRI will waive admission fees to the 2019 Revenue Integrity Symposium for all selected speakers and co-speakers. Click here to learn more and complete the call for speakers application. Contact NAHRI Director Jaclyn Fitzgerald at jfitzgerald@hcpro.com with questions.

Take this 5-minute survey for a chance to win a webinar

Feb 15, 2019
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The Bottom Line

We’re conducting a brief survey to better understand your PDPM training needs. The first five participants who take the survey will receive a free, on-demand webinar of your choice. This is a quick survey and we greatly appreciate your feedback.

 Here's the URL to take the survey. Click the link or copy and paste it into your browser: https://www.surveymonkey.com/r/B53QM5G.

Please complete the survey before Monday, February 18 to be entered to win. Thank you!

Featured member resource: Admission Audit

Feb 15, 2019
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The Bottom Line

These audits occur generally five days after an admission (not too early/not too late). The goal is to capture the completion of assessments, care plans, accuracy in medication reconciliation, and orders from the hospital. Depending on the findings, an opportunity for correction via late-entry documentation can occur to help ensure a clean claim. Download the Admission Audit.

Billing for surgical dressings

Feb 08, 2019
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Billing Alert for Long-Term Care

Surgical dressings are limited to primary dressings, which are therapeutic or protective coverings applied directly to wounds or lesions that are on the skin or are caused by an opening to the skin, and to secondary dressings that are therapeutic or protective (i.e., are needed to secure the primary dressing).

Determining when to adjust or cancel a claim

Feb 08, 2019
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The Bottom Line

If a provider discovers a claim was paid incorrectly or in error, it is important that he or she takes the initiative to make a correction. Adjustment claims are also appropriate to add other charges to the claim, such as if an invoice for an ancillary item is received after the billing has been completed or was simply overlooked when the claim was prepared. Keeping Medicare funds that were improperly paid is considered Medicare fraud.

Map for determining included vs. excluded services under consolidated billing

Feb 08, 2019
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The Bottom Line

Navigating the myriad rules, policies, and special cases that shape SNF CB—including distinguishing between services that are included in consolidated billing and those that must be billed for separately—can be daunting, but learning to do so is critical. CMS’ charts published in their revised SNF PPS booklet can help billers easily determine whether institutional or professional services are included or excluded from CB. Download these mapping tools for determining institutional services and professional services under CB.

CMS update changes requirements for functional reporting

Feb 01, 2019
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The Bottom Line

CMS announced an update on therapy caps and functional reporting in an MLN Matters article dated January 25, 2019. Effective for dates of service on or after January 1, 2018, providers of therapy services shall continue to report the KX modifier on claims as applicable. The modifier no longer represents an exception request but serves as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record after the beneficiary has exceeded the threshold of incurred expenses

New member resource: PDPM Ballpark Projections Questionnaire

Feb 01, 2019
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The Bottom Line

The PDPM Ballpark Projections Questionnaire created by HCPro’s postacute regulatory specialist Stefanie Corbett, DHA, allows SNFs to project what the minimum rate component for reimbursement will be under PDPM. The questionnaire lists important items to be considered during admission, such as “how many days does the resident have left in his/her benefit period?”

New white paper available: The role of ICD-10 in PDPM

Jan 25, 2019
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The Bottom Line

Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.

Read the full, members-only white paper.

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