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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Implications of consolidated billing under PDPM

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Billing Alert for Long-Term Care

Under CMS’ new payment model to be implemented October 1, 2019, the Patient-Driven Payment Model (PDPM), clinical complexity will be the focus of increased payment opportunity. Facilities will receive greater reimbursement for more acute (sicker) patients, such as those with certain cancers, HIV/AIDS, multiple pressure ulcers, and morbid obesity.

Such residents tend to have greater care costs (drugs, equipment, supplies, etc.). Consolidated billing (CB) requirements describe what care costs are covered by the skilled nursing facility (SNF) prospective payment system (PPS) and occasionally Medicare Part B.

How PDPM will affect SNF consolidated billing

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The Bottom Line

The final payment rule for SNFs is here. Under the Patient-Driven Payment Model (PDPM), SNFs can expect greater reimbursement for residents with more clinical complexity, higher acuity, and multiple comorbidities. It will be critical for facilities to understand SNF consolidated billing to properly anticipate the projected revenue and costs of care with the advent of this new model.

[WEBINAR] Consolidated billing: How new payment reform affects SNFs

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The Bottom Line

The final payment rule for SNFs is here. Under the Patient-Driven Payment Model (PDPM), SNFs can expect greater reimbursement for residents with more clinical complexity, higher acuity, and multiple comorbidities. It will be critical for facilities to understand SNF consolidated billing to properly anticipate the projected revenue and costs of care with the advent of this new model.

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.

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.

Consolidated billing stage-specific strategies for compliance

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The Bottom Line

Failure on the part of the SNF to fulfill its Medicare program obligations. Whether it’s communicating a beneficiary’s Part A status to the appropriate parties or estab­lishing a valid payment arrangement with an outside service provider, skirting a responsibility that affects both care decisions and billing practices can have signifi­cant ramifications for SNFs.

Six steps to ensuring a solid SNF billing system

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Billing Alert for Long-Term Care

Completing a Medicare claim correctly isn’t the only requirement to ensure accurate Medicare reimbursement and compliance. Additional steps must be taken to determine that Medicare is the proper payer—or, if it is not, who is. And because medical review is becoming the norm rather than the exception, it is important that claims be triple checked prior to submitting them for payment. If an error is made, it could result in overpayment to the SNF or denial of the claim. Either way, a pattern of errors will be a red flag to the Medicare Administrative Contractor (MAC). Therefore, it behooves the SNF to review its own claims and documentation closely before submitting them. This article outlines several methods for doing so.

Calling all experts! Get involved in educating other long-term care professionals.

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The Bottom Line

The Billers’ Association is seeking long-term care managers, revenue cycle enthusiasts, and billing professionals to join our growing ad-hoc list of experts interested in contributing to articles in our monthly publication, Billing Alert for Long-Term Care. This digital newsletter provides expansive regulatory coverage, including MDS changes, reimbursement issues, and expert advice and analysis to help improve job performance in all aspects of the revenue cycle management system.

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