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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How to determine overall facility star rating

August 8, 2017
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Billing Alert for Long-Term Care

When determining how many points each of your Quality Measures (QM) is receiving, the 5-star report is used to compare the facility rating to the specific ranges of the cut point tables for each measure. Each measure has its own cut point table to determine how many points are assigned at each threshold. The higher the number of points, the higher the ranking (between one and five stars for the QM domain overall). This star rating is then compared to the health inspection stars and the staffing stars to determine the final overall facility star rating.

 

Medicare managed care appeals and grievances

July 6, 2017
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The Bottom Line

Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare Advantage regulations.  For a detailed discussion of the Medicare managed care grievance and appeals processes, click here.

New Medicare cards offer greater protection to more than 57 million Americans

June 2, 2017
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The Bottom Line

New cards will no longer contain Social Security numbers, to combat fraud and illegal use

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

Defining maintenance therapy: A proactive approach to quality care

May 5, 2017
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Billing Alert for Long-Term Care

In February 2017 a federal judge accepted Medicare’s plans to better educate the public about individuals’ eligibility for coverage of physical and occupational therapy and speech-language pathology services. These updated plans came as a result of the Jimmo Settlement, a solution to the lengthy class action originally filed in 2011 by six individual Medicare beneficiaries and seven national organizations against the Secretary of Health and Human Services.

Technical experts needed for the CMS SNF QRP panel

May 2, 2017
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The Bottom Line

The Centers for Medicare & Medicaid Services (CMS) has contracted with RTI International to develop and maintain quality measures for the SNF QRP. The purpose of this project is to develop quality measures reflective of quality of care for post-acute care (PAC) settings to support CMS quality missions. Quality measures will be developed consistent with the three broad aims and six priorities of the National Quality Strategy, and the CMS Quality Strategy.

Medicare fraud and improper payments remain black stain under President Trump’s microscope

April 14, 2017
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Billing Alert for Long-Term Care

An alarming fact: Medicare loses more money to overbilling than any other program government-wide. The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program, which is used to estimate improper payments made by Medicare, determined that more than $130 billion has been inappropriately lost by Medicare over the past three years due to improper payments. Even more disturbing, healthcare officials warn that without a change in payment distribution, the Medicare Trust Fund is on a path to becoming bankrupt by 2028.

 

Transforming Health Care Delivery through the CMS Innovation Center: Better Care, Healthier People, and Smarter Spending

March 10, 2017
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The Bottom Line

CMS has made great progress in recent years on reforming our system into one that delivers better quality of care for patients and pays for care in a smarter way, including investing more in prevention and primary care.

Eight ways to improve the transition process between hospitals and SNFs

March 3, 2017
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Billing Alert for Long-Term Care

There are few times during a SNF stay that a resident is more vulnerable than those first several days. Often, a bad transition process only serves to exacerbate those vulnerabilities, leading to complications or rehospitalization.

In fact, a  study published in the Journal of Post-Acute and Long Term Care shows that poor coordination between hospitals and postacute care providers can have devastating consequences for residents, particularly those with higher acuity.

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