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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New mobile app allows consumers to see what Original Medicare covers

Feb 08, 2019
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The Bottom Line

Earlier this month CMS announced the release of a new app, “What’s Covered,” that allows people to quickly look up what Original Medicare covers using their mobile device. In addition to the “What’s Covered” app, CMS is enabling beneficiaries to connect their claims data to applications and tools developed by innovative private-sector companies to help them understand, use, and share their health data through Blue Button 2.0.

Navigating tax reform in 2019

Feb 01, 2019
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Billing Alert for Long-Term Care

After speaking with a few subject matter experts about the new tax laws, Billing Alert for Long-Term Care has the good, the bad, and the salvageable for 2019 tax reform. For some long-term care (LTC) facilities, these changes will have significant dollar impacts on 2018 tax returns, while other facilities will slip through the IRS’ narrow cracks mostly unaffected. Just as the care plan for each resident should be individualized to his or her care needs, each facility’s approach to taxes this year should be customized to its unique situation. Here are a few changes to keep in mind and discuss with your certified public accountant (CPA) before submitting this year’s tax return.

The real impacts of poor quality, inadequate compliance, and weak risk management

Jan 25, 2019
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Billing Alert for Long-Term Care

The assisted living and skilled care industry today is going through a rocky patch. A solid half of the skilled nursing facility (SNF) industry is struggling due to Medicare Advantage, softer demand, pervasive reliance on Medicaid for census, labor shortages, rising wage pressure, tight Medicare reimbursement, and new regulations, etc. While its struggles are not as pervasive as SNFs’, assisted living is facing challenges due to softer census, overcapacity, rising resident acuity, labor costs and shortages, and increasing regulatory scrutiny. The relative strength in the overall senior and postacute sector is home health and independent housing; however, while home health demand is good, regulatory overburden is still present, along with tight reimbursement and labor challenges. Independent housing’s market and sub-market rent side remain strong; however, many high-end providers are still struggling with census challenges and soft demand in certain markets.

Words on the street: Acronyms of PDPM

Jan 04, 2019
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Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

Key elements of ACO program overhaul

Dec 27, 2018
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The Bottom Line

CMS finalized a rule with new requirements for accountable care organizations (ACO) last week, reducing the amount of time an ACO is allowed to stay in the program without assuming risk and expanding the three-day stay waivers for nursing homes. “Most Medicare ACOs do not currently face financial consequences when costs increase, but a review of the data on ACO performance shows that over time those ACOs that take accountability for costs perform better than those that do not,” said CMS administrator Seema Verma in a blog post dated December 21, 2018.

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.

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