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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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.

Proposed payment rule PDPM: What SNFs need to know

June 1, 2018
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The Bottom Line

The Patient-Driven Payment Model (PDPM), as proposed, is designed to replace the current SNF payment methodology known as RUG-IV. Unless date changes, etc. are made by CMS post commentary review, the effective date of the change (from resource utilization groups to PDPM) is October 1, 2019. PDPM as an outgrowth of the initially proposed resident classification system (RCS) and received commentary is a simplified payment model designed to be more holistic in patient assessment, capture more clinical complexity, eliminate or greatly reduce the therapy focus by eliminating the minute levels for categorization, and simplifying the assessment process and schedule (reducing to three possible assessments/MDS tasks). Below is a summary of PDPM core attributes/features as proposed. Click here to access the PDPM Calculation Worksheet for SNFs that provides additional details beyond the reference points below.

Protecting electronic resident health information

May 24, 2018
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Billing Alert for Long-Term Care

The use of electronic health records (EHR) is a growing trend in long-term care today. Acute care settings have led the way in replacing paper records, resulting in improved quality and efficiency, as well as lower costs. As long-term care facilities are following their lead, they should not allow these potential benefits to overshadow the increasingly challenging necessity to secure and protect resident health information.

President “will keep turning up the pressure” until pharmaceutical industry puts patients first

May 17, 2018
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The Bottom Line

During remarks on President Trump’s drug pricing blueprint held in Washington, D.C. earlier this week, Secretary of Health and Human Services (HHS) Alex Azar II talked about patients who have been “let down by all the players in our drug pricing system” as a result of high prescription drug prices. To fix this problem, HHS is putting forth a proposed set of changes that Azar referred to as “more sweeping than any drug-pricing initiative ever,” and “more bold than any set of proposals set forth before.”

Patient-driven payment model, survey, and quality: Understanding MDS accuracy and what you need for success

May 11, 2018
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Billing Alert for Long-Term Care

On Friday, April 27, 2018, the Centers for Medicare & Medicaid Services (CMS) published a highly anticipated proposed rule containing a recommendation to replace the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV). The proposed model, Patient-Driven Payment Model (PDPM), significantly revises the Resident Classification System, Version I (RCS-I), which was introduced as a potential RUG-IV replacement last April in an Advanced Notice of Proposed Rulemaking.

Should traditional Medicare cover chronic care?

May 10, 2018
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The Bottom Line

Considering adding chronic care as a benefit under traditional Medicare coverage started with the idea of adding it under Medicare Advantage (MA) for the 2019 benefits package. MA program managers presented the idea earlier this week in Washington, according to ThinkAdvisor, and although it was well-received, feedback from witnesses included a suggestion that adding the benefit shouldn’t exclude beneficiaries who receive traditional Medicare.

CMS makes major revisions to RCS model, introduces new proposed Patient-Driven Payment Model

April 30, 2018
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The Bottom Line

Many concerns and questions from stakeholders followed the introduction of the Resident Classification System (RCS),  a proposed replacement for the Prospective Payment System’s RUG-IV model published in an Advanced Notice of Proposed Rule-Making (ANPRM) last April. Highly anticipated ever since, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule late Friday, announcing significant revisions to the RCS model. The result? The Patient-Driven Payment Model (PDPM).

Calling all experts! Get involved in educating other long-term care professionals.

April 26, 2018
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The Bottom Line

The Billers’ Association is seeking long-term care managers, revenue cycle enthusiasts, and billing professionals to join our growing ad-hoc list of experts interested in contributing to articles in our monthly publication, Billing Alert for Long-Term Care. This digital newsletter provides expansive regulatory coverage, including MDS changes, reimbursement issues, and expert advice and analysis to help improve job performance in all aspects of the revenue cycle management system.

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