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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ICD-11 is here and U.S. is mulling its use for mortality reporting

Nov 30, 2018
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Billing Alert for Long-Term Care

As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption. That would be the International Classification of Diseases 11th Revision, otherwise known as ICD-11, which was released by the World Health Organization (WHO) in June after a decade in development. And U.S. officials are already considering a switch to the codes—for use on death certificates.

Reporting physician visits for SNF patients

Nov 16, 2018
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Billing Alert for Long-Term Care

by Peggy S. Blue, MPH, CPC, CCS-P, CEMC

This article has been republished from JustCoding.com.

Per the 2018 CPTÒ Manual, nursing facility services are reported using CPT codes 99304–99318. Notice that the heading for this category is Nursing Facility Services rather than Skilled Nursing Facility Services. It would be clearer if the heading was Skilled Nursing Facility Services as these E/M services can be administered to patients in skilled nursing facilities (SNF), intermediate care facilities, psychiatric residential treatment centers, or long-term care facilities.

473 changes to ICD-10 codes

Oct 19, 2018
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Billing Alert for Long-Term Care

Coding tells the detailed story of your facility’s patient care, morbidity, and sometimes demographic information. ICD-10 coding in long-term care has several purposes, including to:

  • Collect diagnostic and statistical data
  • Support clinical decision-making
  • Verify medical necessity
  • Validate need for supportive procedures, treatments, and therapies
  • Support reimbursement for services provided
  • Determine RUG scores
  • Correctly code diseases on the MDS, UB-04, medical reports, therapy treatments, and ancillaries

New HCPCS code, Q5110, effective October 1, 2018

Sep 28, 2018
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The Bottom Line

A revised MLN Matters article regarding updated healthcare common procedure coding system (HCPCS) drug/biological code changes deleted the note that stated MACs should hold claims for HCPCS codes Q5108 and Q5110 until CR10834 is implemented, since that is no longer a requirement. The article was originally released on August 10, 2018 and revised on September 13, 2018.

FY 2019 release of ICD-10-CM now available

Aug 09, 2018
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The Bottom Line

The National Center for Health Statistics  recently released the 2019 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2018, through September 30, 2019, which include updated language and added specificity for classifying diagnoses. The guidelines include updated language conventions to improve coding accuracy. Per guideline I.C.1.15, “with” or “in” should be interpreted to mean “associated with” or “due to” when they appear in the Alphabetic Index (either under a main term or subterm), a code title, or an instructional note in the Tabular List. 

HCPCS codes used for SNF consolidated billing updated

Jul 26, 2018
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The Bottom Line

CMS published an MLN Matters article this week announcing an update to the lists of Healthcare Common Procedure Coding System (HCPCS) codes that are subject to the Consolidated Billing (CB) provision of the SNF Prospective Payment System (PPS). Changes to Current Procedural Terminology (CPT)/HCPCS codes and Medicare Physician Fee Schedule designations are to revise Common Working File (CWF) edits to allow MACs to make appropriate payments in accordance with policy for SNF CB in the “Medicare Claims Processing Manual”, Chapter 6, Section 20.6. Make sure your billing staffs are aware of these changes.

Verify claim accuracy for ICD-10

Jul 13, 2018
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The Bottom Line

Claims errors are the number one reason for additional development requests (ADRs) and a major cause for claims being suspended under medical review. The diagnosis codes used should tell a story about why the patient is receiving services. In the SNF setting, the reason for admission to the SNF may not be the reason for admission to the hospital.

What should your policy for coding compliance and ethics include?

Jun 15, 2018
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The Bottom Line

Coding continues to be a prime target for audits because errors, gaps, and missing information are easily identified. Also, the bundling and unbundling of codes impacts every area of healthcare. Additionally, coding is identified in audits and investigations and may be a source for whistleblower allegations under the False Claims Act.

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.

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