Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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FY 2019 release of ICD-10-CM now available

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The Bottom Line

The National Center for Health Statistics  recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2018, through September 30, 2019, which include updated language and added specificity for classifying diagnoses. The guidelines include updated language conventions to improve coding accuracy. Per guideline I.C.1.15, “with” or “in” should be interpreted to mean “associated with” or “due to” when they appear in the Alphabetic Index (either under a main term or subterm), a code title, or an instructional note in the Tabular List. 

Consolidated billing: Navigating special cases

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Billing Alert for Long-Term Care

Oftentimes, claim rejections and negative outcomes from billing compliance audits are results of ineffective or nonexhaustive processes within the skilled nursing facility (SNF). This article will help providers lay the foundation for a comprehensive billing system that safeguards against these pitfalls by highlighting special consolidated billing (CB) cases whose navigation could otherwise throw a wrench in workflows.

PPD as the benchmark for measurement

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Billing Alert for Long-Term Care

In long-term care, especially within the nursing home sector, per patient days (PPD), a financial cost measurement tool, is looked at as the gold standard of financial measuring devices in the industry. Administrators should be thoroughly conversant in the concept of PPD, which is often measured in hours or dollars per patient day and is the cornerstone for monitoring your facility’s daily financial status.

HCPCS codes used for SNF consolidated billing updated

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The Bottom Line

CMS published an MLN Matters article this week announcing an update to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). Changes to Current Procedural Terminology (CPT)/HCPCS codes and Medicare Physician Fee Schedule designations are to revise Common Working File (CWF) edits to allow MACs to make appropriate payments in accordance with policy for SNF CB in the “Medicare Claims Processing Manual”, Chapter 6, Section 20.6. Make sure your billing staffs are aware of these changes.

Verify claim accuracy for ICD-10

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The Bottom Line

Claims errors are the number one reason for additional development requests (ADRs) and a major cause for claims being suspended under medical review. The diagnosis codes used should tell a story about why the patient is receiving services. In the SNF setting, the reason for admission to the SNF may not be the reason for admission to the hospital.

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