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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Map for determining included vs. excluded services under consolidated billing

Feb 08, 2019
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The Bottom Line

Navigating the myriad rules, policies, and special cases that shape SNF CB—including distinguishing between services that are included in consolidated billing and those that must be billed for separately—can be daunting, but learning to do so is critical. CMS’ charts published in their revised SNF PPS booklet can help billers easily determine whether institutional or professional services are included or excluded from CB. Download these mapping tools for determining institutional services and professional services under CB.

Consolidated billing: Fact or fiction?

Dec 27, 2018
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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.

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.

‘Tis the season for SNF leaves of absence, are you prepared?

Dec 07, 2018
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Billing Alert for Long-Term Care

In preparing for the holiday festivities, it is essential for friends and family to understand that even if their loved ones are in a nursing home or skilled nursing facility (SNF), they can still partake in the holiday parties and goodie exchanges without putting their Medicare coverage at risk. Identifying the specific effects that a beneficiary’s leave of absence (LOA) can have on billing has long been hazy territory for SNFs, however, as they sometimes confuse Medicare’s consolidated billing (CB) requirements with internal definitions and policies they’ve developed for a beneficiary’s temporary exit from the facility.

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.

Implications of consolidated billing under PDPM

Oct 12, 2018
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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

Sep 07, 2018
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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

Aug 24, 2018
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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

Aug 09, 2018
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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.

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