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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Submit your PDPM questions to CMS for December 11 call

Nov 30, 2018
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The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

Healthcare winners and losers from election night 2018

Nov 09, 2018
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The Bottom Line

Source: HealthLeaders

The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them. The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate. Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.

Trump administration’s proposed rule aims to penalize legal immigrants for using Medicaid

Oct 12, 2018
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The Bottom Line

The Trump administration’s proposed rule issued on Wednesday raises concerns about the health of public health efforts and threatens healthcare, nutrition, and housing assistance for millions of low-income legal immigrant families. The proposal, published in the Federal Register by the Department of Homeland Security, would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency, reports Modern Healthcare.

SNF final rule: Prepare for PDPM

Sep 14, 2018
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The Bottom Line

CMS’ final rule, effective in October 2019, is a major overhaul for the long-term care industry, including SNFs. To survive, stakeholders must understand how reimbursement will work and how their facilities will need to function. Join expert speaker Stefanie Corbett, DHA, on Wednesday, October 24, 1:00-2:00pm, ET, for this 60-minute webinar. Learn what you need to know about the new case-mix groupings, how therapy is affected, and what SNFs need to do to remain viable in this new landscape.

Calculating reimbursement under PDPM

Sep 07, 2018
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Billing Alert for Long-Term Care

Many staff members in a skilled nursing facility (SNF) have contributed to the minimum data set (MDS) under the current SNF prospective payment system, but few are able to explain how that documentation converts to a dollar amount or understand how the Centers for Medicare & Medicaid Services (CMS) defines a RUG rate. To help providers prepare for the transition from RUG-IV to CMS’ new Patient Driven Payment Model (PDPM), a calculation worksheet has been made available so staff will be able to explain how care services translate into reimbursement rates by the new payment model’s implementation date, October 1, 2019.

Combing patient records for additional diagnosis codes reaps massive returns for Medicare Advantage plans

Sep 07, 2018
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The Bottom Line

Under traditional Medicare in a SNF, diagnosis codes don’t have a significant impact on reimbursement. Medicare Advantage plans, however, contain a built in incentive that encourages providers to code all diagnoses possible in order to receive optimal payment, which in recent cases has led to retrospective chart review of patients’ medical charts to identify additional diagnosis codes for submission to CMS.

Stark law reform push sees movement on multiple fronts

Aug 31, 2018
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The Bottom Line

The window closed Friday night for public comments on a Centers for Medicare & Medicaid Services request for information regarding possible changes to Stark Law and anti-kickback regulations on the healthcare industry. When the agency announced the RFI earlier this summer, CMS Administrator Seema Verma signaled that both the laws and the regulations stemming from them could be impeding value-based care. Many commenters agreed, arguing that the decades-old restrictions should be scaled back to make room for the industry to generate and implement new ideas.

10 things you need to know about CMS’ final SNF PPS rule, and PDPM

Aug 31, 2018
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Billing Alert for Long-Term Care

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register dated August 8, 2018, the Patient-Driven Payment Model (PDPM)--the new case-mix methodology to replace RUG-IV--is effective October 1, 2018. Facilities will have a year to transition to PDPM from RUG-IV by the October 1, 2019 implementation date. The final rule also establishes a 2.4% market basket update, meaning an $820 million raise for SNFs beginning October 1, 2018.

LTC nurse residency results in: 86% retention rate

Aug 17, 2018
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Billing Alert for Long-Term Care

Postacute care has become an essential component of value-based care. By preparing new nurses through a long-term care residency program, facilities can improve nurse retention, confidence, and competency. Accountable care organizations, value-based care, and new reimbursement models are changing the healthcare landscape, and with that the role of the postacute care nurse is evolving as well. "It's important that [patients] don't go back to the hospital. So these nurses have to have a different skill level than, maybe, what people perceived long-term care as previously," says Edna Cadmus, PhD, RN, NEA-BC, FAAN, clinical professor at Rutgers University School of Nursing.

CMS administrator aims to make doctors’ offices a “fax free zone” by 2020

Aug 16, 2018
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The Bottom Line

During the ONC’s Interoperability Forum in Washington, D.C. this month CMS administrator Seema Verma announced the agency’s goal to replace fax machines used in physician offices to send patient information with consumer-friendly applications. According to Healthcare Finance News, the applications will be used by Medicare beneficiaries who will be able to “connect their claims data to the applications, services and research programs they trust.”

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