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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Updates to MDS 3.0 FY2019

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The Bottom Line

Changes to the Minimum Data Set (MDS) for skilled nursing facilities (SNFs) for the fiscal year 2019 include mechanical fixes (i.e. grammar, punctuation, capitalization, and text updates), clarifications and new items. Want a hard copy of this best-selling MDS 3.0 RAI User’s Manual? Check out HCPro’s version published with the latest updates on September 19, 2018. Facilities should prepare for the updates to the following sections effective October 1, 2018.

Key documentation criteria for supporting the Medicare claim

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Billing Alert for Long-Term Care

Medicare documentation must provide accurate information to support the necessity of skilled services provided to a resident. Nursing documentation is vital and must reflect the reason for admission to skilled services, the delivery of skilled services, and justification for skilled services to continue. All of these elements, combined with the documentation within the entire medical record, help to justify and support your Medicare claim.

Seven tips for reviewing and responding to PEPPER reports

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The Bottom Line

Every April, CMS makes the Program for Evaluating Payment Patterns Electronic Report (PEPPER) available for SNFs. The agency offers variant reports for a number of other Part A provider types, including hospitals, home health agencies, and hospices. These tools, which provide comparative billing data across a handful of setting-specific risk areas, can play an important part in a provider’s corporate compliance and ethics program. To get the most out of the report, SNFs should have a strategy in place for integrating its findings into their corporate compliance and ethics program before accessing this year’s edition. 

Resident-centered care in a data- and payment-driven industry

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Billing Alert for Long-Term Care

SNFs must provide quality care to residents in a field that is being suffocated by regulation and paperwork, and that is placing ever-increasing importance on data. The key is to ensure the data does not eclipse the care. SNFs must adhere to the principle that putting residents first will improve quality measures, increase reimbursement rates, and ensure a successful survey. Enhancing resident care will then give a facility the reputational excellence it needs to fill its beds. 

Did you miss our live webinar, PBJ Updates, July 2018?

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The Bottom Line

Listen to our on-demand version any time! Postacute regulatory specialist Stefanie Corbett, DHA, covered PBJ changes that took effect June 1, 2018 and explained how PBJ data impacts facilities’ five-star rating on Nursing Home Compare beginning April 1, 2018. She also reviewed FTag 851 and the consequences for failing to report or inaccurately reporting PBJ, as well as tips for ensuring accurate reporting.

New proposed payment system, Part 2: Changes to the RAI process

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Billing Alert for Long-Term Care

The Centers for Medicare & Medicaid Services’ (CMS) new proposed payment system, the Patient-Driven Payment Model (PDPM), follows multiple recommendations from the Medicare Payment Advisory Commission to revise the current prospective payment system (PPS). The revisions include transitioning reimbursement from a volume-based to a value-based system, which accounts for individual patient characteristics, captures more clinical complexity, and reduces the focus on therapy minutes by correlating reimbursement with a broader spectrum of care services.

Case studies and scenarios: Various types of audits

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Billing Alert for Long-Term Care

Most audits are conducted in very similar manners. They also determine their focus using very similar techniques. Recovery Audit Contractors (RAC) are announcing their focus for complex reviews on their websites. The main difference between them is what they are specifically looking for. These examples are taken from various real-life scenarios and potential scenarios.

A tool for your CNAs to help with accurate ADL documentation

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The Bottom Line

The SNF PPS establishes a schedule of Medicare assessments, and each assessment supports reimbursement. These scheduled assessments establish per diem payment rates for associated standard payment periods. A very important element that feeds PPS reimbursement is the measurement of the level of independence each resident has in activities of daily living (ADLs) for the late-loss ADLs: bed mobility, transfer, toilet use, and eating. Each is a cost center category, and it becomes highly important that certified nursing assistants/geriatric nursing assistants, who typically perform these observations and tasks, understand the need to accurately document the level of assistance provided to the resident.

What are you doing in August?

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The Bottom Line

Join us in Chicago on Monday and Tuesday, August 13-14, to attend our SNF Regulatory Update Boot Camp! This event covers the industry changes that impact your clinical and financial operations while providing strategies for achieving and sustaining compliance in the future marketplace. Attendees can expect to learn best practices for leading and managing facilities to avoid survey issues, claims audits, and improper Medicare payments.

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