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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OIG highlights from 2018

Feb 15, 2019
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Billing Alert for Long-Term Care

The Office of Inspector General’s (OIG) studies can serve as a good alert system for long-term care facilities as well as the regulators who monitor them. We’ve compiled a list of relevant reports and recommendations published by the OIG in 2018 to help you prioritize your quality and compliance goals for this year.

States now required to conduct at least 50% of off-hour surveys on weekends for facilities with potential staffing issues

Jan 25, 2019
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The Bottom Line

A list of facilities with potential staffing issues is being provided to CMS regional offices and state survey agencies to support survey activities for evaluating sufficient staffing, according to a memo released by CMS back in November, 2018. The memo states that “while CMS is encouraged by facilities’ efforts to improve staffing,” payroll based journal (PBJ) data has raised a few concerns, prompting them to inform state survey agencies of facilities with potential staffing issues. These issues include facilities with significantly low nurse staffing levels on weekends and facilities with several days in a quarter without an RN onsite.

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.

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.

Resident-centered care in a data- and payment-driven industry

Jul 19, 2018
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Billing Alert for Long-Term Care

SNFs must provide quality care to residents in a field that is being suffocated by regulation and paperwork, and that is placing ever-increasing importance on data. The key is to ensure the data does not eclipse the care. SNFs must adhere to the principle that putting residents first will improve quality measures, increase reimbursement rates, and ensure a successful survey. Enhancing resident care will then give a facility the reputational excellence it needs to fill its beds. 

Case studies and scenarios: Various types of audits

Jun 29, 2018
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Billing Alert for Long-Term Care

Most audits are conducted in very similar manners. They also determine their focus using very similar techniques. Recovery Audit Contractors (RAC) are announcing their focus for complex reviews on their websites. The main difference between them is what they are specifically looking for. These examples are taken from various real-life scenarios and potential scenarios.

Three new regulatory requirements that implicate service contracts

Jun 28, 2018
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The Bottom Line

Having effective contracts in place in your facility can help minimize regulatory and financial risk under CMS’ Conditions of Participation (CoP) and federal fraud and abuse laws. If regulatory risk is not addressed in the facility’s service contracts, it could subject the facility to a host of costly fraud and abuse implications.

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