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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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.

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.

HCPCS codes used for SNF consolidated billing updated

Jul 26, 2018
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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

Jul 13, 2018
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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.

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