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

What are SNF billers talking about this month?

Jan 18, 2019
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Billing Alert for Long-Term Care

The following Q&A comes from the Billers' Association for Long-Term Care talk forum, Biller's Talk.

Q: Is the facility required to give a Notice of Medicare Non-Coverage (NOMNC) to a benefit-exhausted resident?

A: An NOMNC is not required by CMS regulation to be issued in relation to benefit exhaust; however, it is not wrong or held against a facility to issue one at that time. Some organizations with multiple facilities require the NOMNC to be issued as a best practice and as part of their policy and procedures, even in the event that the Medicare Part A services are terminated due to benefit exhaust.

The regulations regarding NOMNCs can be found at CMS.gov in the Medicare Claims Processing Manual, Chapter 30, Section 260.

CMS alert: CY2019 DMEPOS fee schedule update and KX modifier amounts

Jan 18, 2019
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The Bottom Line

CR 11064 (MLN Matters) provides the Calendar Year 2019 annual update for the Medicare DMEPOS fee schedule. The update includes information on the data files, new and deleted HCPCS codes, adjusted fee schedule amounts, and other information related to the update of the fee schedule. Click here to read the full article.

Revenue integrity enthusiasts: Do you have what it takes to present at RIS?

Jan 18, 2019
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The Bottom Line

The National Association for Healthcare Revenue Integrity (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. RIS attendees will be eligible to earn CHRI CEUs and speakers will be eligible to earn additional CHRI CUEs. Speakers are welcome to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute and long-term care settings. Click here to learn more.

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!

Triple check monthly billing review

Jan 11, 2019
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The Bottom Line

Implementing a triple check process in your facility not only helps improve therapy and nursing documentation, but can also assist in monitoring and identifying areas of discrepancy and opportunity to improve the management of the Medicare Part A process. Performing a monthly billing review can help ensure that critical elements are present on the MDS to ensure optimum payment. Download our triple check monthly billing review tool to keep each item organized and tracked.

Reminder to pharmacies for correctly billing Part B claims using KX modifier for immunosuppressive drugs

Jan 11, 2019
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The Bottom Line

In response to a 2017 OIG report noting that some pharmacies billed Medicare incorrectly for Part B claims using the KX modifier for immunosuppressive drugs, CMS has published several resources to clarify manual instructions and help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources include the following:

Words on the street: Acronyms of PDPM

Jan 04, 2019
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Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

Consolidated billing: Fact or fiction?

Dec 27, 2018
 | 
The Bottom Line

Test your CB knowledge with the following fact or fiction scenarios:

Fiction

A SNF does not need to list all the CB-included services it renders on the consolidated bill’s claim form because the provider won’t be reimbursed for each specific service anyway.

Fact

Yes, the SNF does. Otherwise, the provider is out of compliance with Medicare’s rules for consolidated billing—a lapse that could result in the recoupment of any identified overpayments.

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