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

July 18, 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

July 13, 2018
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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

June 29, 2018
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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

June 22, 2018
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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.

New proposed payment system, part I: Case-mix components drill-down

June 8, 2018
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Billing Alert for Long-Term Care

With the release of the proposed rule on April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) introduced the Patient-Driven Payment Model (PDPM) with a proposed implementation date of October 1, 2019. This model is intended to replace the current prospective payment system reimbursement structure, Resource Utilization Groups, Version IV (RUG-IV), and significantly revises the Resident Classification System, Version I (RCS-I), which was introduced to the industry as a proposed RUG-IV replacement in an Advanced Notice of Proposed Rule Making (ANPRM) in 2017. RCS-I and PDPM were developed in conjunction with Acumen, a consulting group hired by CMS, and an interdisciplinary technical expert panel.

What are you doing in August?

June 8, 2018
 | 
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.

Managed care admissions: Bridging the communication gap between admissions and the business office

June 1, 2018
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Billing Alert for Long-Term Care

Due to the complex nature of managed care (MC) insurance as compared to traditional Medicare, staff education and training in these types of admissions can be difficult. For one, it’s easier to find information on requirements for traditional Medicare because it’s more uniform than the various managed care plans, which each have their own rules and criteria for payment. For another, MC plans require referrals for provider services, meaning that the facility must verify what prior approvals are needed before services are rendered to ensure payment.

Q&A: Post-Medicare audit processes

May 18, 2018
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Billing Alert for Long-Term Care

Q: What should we do if we feel that the auditor’s findings are blatantly wrong?

A: If it is felt the auditor was blatantly wrong, providers should contact the agency immediately to discuss it. For instance, if there was a prescription, but it wasn’t in the file that the auditor had, then it would not be considered an error on the auditor’s part, and the facility should follow the appropriate appeals process. But if the auditor made a mistake, he or she should correct it accordingly before proceeding with an overpayment. If the auditor won’t fix the error, then ask to speak with his or her superior about the issue. Providers have the right to accurate decision-making when it comes to claims processing, medical review, and audits.

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