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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SNF final rule: Prepare for PDPM

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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.

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

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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.

Calculating reimbursement under PDPM

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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.

Stark law reform push sees movement on multiple fronts

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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

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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

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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

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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.”

Emphasis on shorter lengths of stay may cause identity crisis among long-term care facilities

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Billing Alert for Long-Term Care

Beneficiary enrollment in Medicare Advantage plans is on the rise, increasing from 5.3 million in 2013 to 19 million in 2017, according to information published by PLOS Medicine. A study released by the nonprofit advocacy organization in June compared postacute rehabilitation use, length of stay, and outcomes experienced by Medicare fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries with hip fractures in the United States. The results? Although MA beneficiaries experienced shorter lengths of stay and less rehab, their return to the community was more successful and their readmission rates were significantly lower compared to the FFS beneficiaries.

CMS publishes SNF PPS final rule, new payment model effective October 1, 2018

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The Bottom Line

It’s official: According to CMS’ Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule published in the Federal Register yesterday evening, 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.

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