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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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.

New member resource: PDPM Ballpark Projections Questionnaire

Feb 01, 2019
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The Bottom Line

The PDPM Ballpark Projections Questionnaire created by HCPro’s postacute regulatory specialist Stefanie Corbett, DHA, allows SNFs to project what the minimum rate component for reimbursement will be under PDPM. The questionnaire lists important items to be considered during admission, such as “how many days does the resident have left in his/her benefit period?”

CMS update changes requirements for functional reporting

Feb 01, 2019
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The Bottom Line

CMS announced an update on therapy caps and functional reporting in an MLN Matters article dated January 25, 2019. Effective for dates of service on or after January 1, 2018, providers of therapy services shall continue to report the KX modifier on claims as applicable. The modifier no longer represents an exception request but serves as a confirmation that services are medically necessary as justified by appropriate documentation in the medical record after the beneficiary has exceeded the threshold of incurred expenses

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.

New CMP amounts adjusted for inflation and quarterly updates to NCCI PTP edits available

Jan 25, 2019
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The Bottom Line

New CMP amounts that have been adjusted for inflation and are effective October 11, 2018 were announced in a final rule published by CMS on January 22, 2019. The adjusted amounts apply to CMPs assessed on or after October 11, 2018. For SNFs, NFs and SNF/NFs, the CMP Analytic Tool instructions and calculations will be updated to reflect these changes. Appendix A of the final rule announcement contains the new rates, which have seen an increase.

States now required to conduct at least 50% of off-hour surveys on weekends for facilities with potential staffing issues

Jan 25, 2019
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The Bottom Line

A list of facilities with potential staffing issues is being provided to CMS regional offices and state survey agencies to support survey activities for evaluating sufficient staffing, according to a memo released by CMS back in November, 2018. The memo states that “while CMS is encouraged by facilities’ efforts to improve staffing,” payroll based journal (PBJ) data has raised a few concerns, prompting them to inform state survey agencies of facilities with potential staffing issues. These issues include facilities with significantly low nurse staffing levels on weekends and facilities with several days in a quarter without an RN onsite.

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.

CMS alert: CY2019 DMEPOS fee schedule update and KX modifier amounts

Jan 18, 2019
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The Bottom Line

CR 11064 (MLN Matters) provides the Calendar Year 2019 annual update for the Medicare DMEPOS fee schedule. The update includes information on the data files, new and deleted HCPCS codes, adjusted fee schedule amounts, and other information related to the update of the fee schedule. Click here to read the full article.

Revenue integrity enthusiasts: Do you have what it takes to present at RIS?

Jan 18, 2019
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The Bottom Line

The National Association for Healthcare Revenue Integrity (NAHRI) is currently seeking speakers to present at the 2019 Revenue Integrity Symposium (RIS), to be held October 15–16, 2019, at the Renaissance Orlando at SeaWorld in Orlando, Florida. RIS attendees will be eligible to earn CHRI CEUs and speakers will be eligible to earn additional CHRI CUEs. Speakers are welcome to present on all aspects of revenue integrity, Medicare compliance, and the revenue cycle in acute and long-term care settings. Click here to learn more.

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