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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Billers’ Association 2019 quarterly webcast dates available, register now!

Dec 14, 2018
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The Bottom Line

As part of your Billers’ Association for Long-Term Care (BALTC) membership, you have access to a webcast each quarter hosted by BALTC Director of Content Brianna Shipley with panelist Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro, and a select BALTC advisory board member. Panelists will discuss a variety of relevant and timely topics, including industry trends, updates, and best practices. Our members will receive guidance from, share opinions with, and have their questions answered by Medicare billing and reimbursement experts!

KX modifier amounts announced for CY19

Dec 07, 2018
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The Bottom Line

The annual per-beneficiary incurred expense amounts are now known as the KX modifier thresholds. These amounts were previously associated with the financial limitation amounts that were more commonly referred to as “therapy caps” before the application of the therapy limits/caps was repealed when the Bipartisan Budget Act of 2018 (BBA of 2018) was signed into law. CMS recently posted a MLN Matters article with these amounts for CY2019, which were lowered by the BBA of 2018 which are as follows.

New member resource for your compliance & ethics program

Dec 07, 2018
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The Bottom Line

As a result of updated survey protocols published in Appendix PP of the State Operations Manual on March 8, 2017, SNFs must have a compliance & ethics program in place by November 28, 2019. Implementing written policies and procedures is one element suggested by CMS to achieve a successful program, and having policies and procedures for the billing department is no exception. Download our Sample Policy for Reporting Overpayments to ensure that any known overpayment received by a federal healthcare program is appropriately refunded to avoid losing revenue dollars.

Case study: Consolidated billing, major category I

Dec 07, 2018
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The Bottom Line

Background: To illustrate the different billing requirements that apply to professional and technical components of a service, consider Malcolm, a beneficiary who visits the physician office in the midst of a Part A SNF stay to receive a chest x-ray. The physician performs the x-ray, then interprets the results. The administration of the x-ray constitutes the technical component, whereas the interpretation of the results represents the professional component of the total x-ray service.

Ambulance Services Included & Excluded Under SNF Consolidated Billing

Dec 05, 2018
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The Bottom Line

If an ambulance is needed to facilitate the provision of a CB category III service, the trip should be accounted for in the SNF’s consolidated bill. Ambulance trips for category III services are not excluded from consolidated billing, regardless of whether or not they meet the medical necessity criteria. Download this quick reference tool, Ambulance Services Included & Excluded Under SNF Consolidated Billing, to identify which ambulance services are included and excluded from SNF consolidated billing.

ICD-11 is here and U.S. is mulling its use for mortality reporting

Nov 30, 2018
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Billing Alert for Long-Term Care

As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption. That would be the International Classification of Diseases 11th Revision, otherwise known as ICD-11, which was released by the World Health Organization (WHO) in June after a decade in development. And U.S. officials are already considering a switch to the codes—for use on death certificates.

Frequently asked questions about Medicare Part B

Nov 30, 2018
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The Bottom Line

Q: How should multiple units of the same HCPCS code given on the same day be listed on the UB-04 (e.g., four units of 97530 in occupational therapy)?

A: Units of the same HCPCS code provided by the same discipline on the same day should be listed on the same line item. In the above example, it would be one line with four units of 97530, and the individual unit charge would be multiplied by four.

Submit your PDPM questions to CMS for December 11 call

Nov 30, 2018
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The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

Q&A from Biller’s Talk

Nov 20, 2018
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The Bottom Line

Q: This is my first time billing for the flu shots, can we add them to our Part A and Part B claims, or does it have to be a separate batch? Can you bill a roster through DDE?

A: Flu vaccines can only be reimbursed by Medicare Part B. They can be submitted via a roster or individual part b claims. You can bill a roster through DDE.

Featured member resource: HIPAA authorization form

Nov 20, 2018
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The Bottom Line

Securing resident health information should be an ongoing effort that is constantly evaluated for effectiveness. There are several widely accepted measures that facilities should implement to protect resident health information and prevent data breaches. Safeguarding residents’ health information has always been a major concern in all healthcare settings, but it has taken on added importance with the implementation of EHRs and evolving HIPAA privacy and security rules

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