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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Using GEM files accurately: How to convert data from ICD-9 to ICD-10

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Billing Alert for Long-Term Care

Using General Equivalency Mapping (GEM) files

GEM is a translation dictionary tool used to accurately and effectively translate or convert data from ICD-9 to ICD-10. This tool can be used by anyone who wants to convert coded data; however, it should not be used to code a claim, and is not a substitute for ICD-10 coding. GEM files are available at www.cms.gov/Medicare/Coding/ICD10/20. The GEMs are also known as crosswalks, as they provide important information linking codes of one system with codes in the other system.

ICD-10 Compliance: ICD-10 Implementation date is just around the corner!

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The Bottom Line

With the ICD-10 implementation date just around the corner, facilities need to be ready now. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Account­ability Act (HIPAA) and all providers regardless of the healthcare setting. In addition, all payers and vendors, including clearinghouses that process claims on behalf of providers, will also be required to transition to this new system.

ICD-10 Compliance: Considering the impact of GEMs

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The Bottom Line

In ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care, authors Maureen McCarthy and Kristin Breese, help SNF organizations consider the impact of reimbursement mapping.

Because of the complexity of mapping options in the GEMs (General Equivalence Mappings), CMS developed a standardized Reimbursement Mapping tool to convert ICD-10 codes to ICD-9 codes primarily for use in legacy systems on a short-term basis. Because of the compromises that had to be made, CMS recommends users modify Reimbursement Mapping to address ICD-9 codes used by their legacy systems that are not mapped. We further recommend users test the mapping using their own frequency data to ensure it adequately addresses the population to which the scheme will be applied.

Internal auditing strategies for ongoing ICD-10 success

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Billing Alert for Long-Term Care

With the October 1 implementation date of ICD-10 now on a fast track to fruition—and no further delays in sight—even the most committed holdouts in the provider community have kicked off initiatives to ensure staff, outside business partners, and workflows can withstand the major coding transition. To ensure that preparations made over the past months (or years) ultimately pay off, SNFs should start laying the groundwork for regular facility-wide audits of ICD-10 systems in the aftermath of implementation—a proactive approach that can help providers verify the strength of ongoing transition efforts and catch any snags before they disrupt essential facility processes.

ICD-10 Compliance: Converting to a new diagnosis coding system

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The Bottom Line

In ICD-10 Compliance: Process Improvement and Maintenance for Long-Term Care, authors Maureen McCarthy and Kristin Breese, help SNF organizations determine the impact of converting to a new diagnosis coding system.In order to accurately determine the impact converting to a new diagnosis coding system will have on any organization, the importance of an assessment phase cannot be understated. A thorough assessment will enable the team to address and reinforce inadequate systems, or provide time to effectively plan the transition to another vendor, should your current vendor choose not to participate in the ICD-10 transition. SNFs will need to know which areas of operations will be affected and if their current or anticipated vendors and payers will be ready.

Q&A: Long-term care ICD-10 coding specifics

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Billing Alert for Long-Term Care

Editor’s Note: This month’s "Q&A" was modified from the HCPro book ICD-10 Essentials for Long-Term Care, written by Karen L. Fabrizio, RHIA, CPRA. ICD-10 Essentials for Long-Term Care provides you with a three-step plan that takes you from understanding the differences between ICD-9 and ICD-10 to full-scale ICD-10 readiness at your facility. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com. To submit a question for upcoming issues, email Managing Editor Olivia MacDonald at omacdonald@hcpro.com.

Q&A: Long-term care ICD-10 coding specifics

 | 
Billing Alert for Long-Term Care

Editor's note: This month's "Q&A" was modified from the HCPro book ICD-10 Essentials for Long-Term Care, written by Karen L. Fabrizio, RHIA, CPRA. ICD-10 Essentials for Long-Term Care provides you with a three-step plan that takes you from understanding the differences between ICD-9 and ICD-10 to full-scale ICD-10 readiness at your facility. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com. To submit a question for upcoming issues, email Managing Editor Olivia MacDonald at omacdonald@hcpro.com.

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