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 white paper available: The role of ICD-10 in PDPM

Jan 25, 2019
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The Bottom Line

Once you come to understand how reimbursement will be calculated under the new skilled nursing facility (SNF) prospective payment system (PPS) model, Patient Driven Payment Model (PDPM), you may wonder why it wasn’t named the Primary Diagnosis Driven Payment Model, but that’s a conversation for another day. What we should be focusing on is the fact that under PDPM, each resident’s primary diagnosis code entered into line I0020B of the minimum data set (MDS) (a new MDS field that will be added effective 10/1/2019) will be used to place the patient into one of ten PDPM clinical categories. These clinical categories are then used as part of the patient’s classification under the physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) components. A resident’s primary diagnosis code is essentially the hinge for that resident’s clinical documentation and reimbursement path, so getting it right is essential in order to achieve accurate reimbursement under PDPM.

Read the full, members-only white paper.

New white paper: Using collaboration to achieve accurate diagnoses claims

May 24, 2018
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The Bottom Line

The American Health Information Management Association’s definition of principal/first diagnosis lists the primary reason for the encounter as determined at the end of the encounter. In the LTC setting, it is referred to as the first listed code, described as “that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.” The primary diagnosis, or the first listed code, is assigned after reviewing the resident’s hospital admission and discharge documentation. In some cases, the primary diagnosis code may apply at the hospital as well as the SNF, but this is not always so.

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

Apr 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.

International Classification of Diseases (ICD)-10 Code Updates

Dec 14, 2016
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The Bottom Line

On October 1, 2016, new International Classification of Diseases (ICD)-10-CM and ICD-10-PCS code sets went into effect. Updating of these codes traditionally occurs on an annual basis, however, during the immediate years leading up to the ICD-9 to ICD-10 transition there was an extended freeze to code updates to support a smooth transition. Therefore, for fiscal year (FY) 2017, updates and revisions include changes since the last completed update (October 1, 2013).

Ongoing auditing for valid ICD-10 codes

Dec 18, 2015
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The Bottom Line

As healthcare professionals become more comfortable with ICD-10, and billing staff begin to find a rhythm in creating and submitting claims under the new system, providers should ensure that core compliance measures established at the time of implementation don’t begin to slip. SNFs, for example, should continue to verify that the most appropriate ICD-10 codes appear on all claims during the creation phase.

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