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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Civil monetary penalties to fund new CMS quality improvement initiative

Nov 30, 2018
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The Bottom Line

CMS announced a three-year quality improvement initiative in a press release on November 20, 2018. The Civil Money Penalty Reinvestment Program (CMPRP) aims to improve residents’ quality of life by equipping nursing home staff, administrators, and stakeholders with technical tools and assistance to enhance resident care. The CMPRP is funded by federal civil money penalties, which are fines nursing homes must pay CMS by law when they are noncompliant with certain regulations and there are serious concerns about the safety and quality of care they provide.

Submit your PDPM questions to CMS for December 11 call

Nov 30, 2018
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The Bottom Line

CMS will hold an informational call on December 11 at 3:00pm, ET, to help providers prepare for the new RUG-IV replacement, the Patient Driven Payment Model (PDPM), to be implemented October 1, 2019. Participants can submit questions prior to the call by sending an email to PDPM@cms.hhs.gov with the subject line “December 11 Call.” Click here to register.

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.

Op ed: Are postacute, site-neutral payments the future?

Nov 20, 2018
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Billing Alert for Long-Term Care

Editor’s note: The following is reprinted with permission from a post on Reg’s Blog dated October 2, 2018, the senior and postacute healthcare news blog written by Reginald M. Hislop III.

In the 2019 OPPS (outpatient PPS) proposed rule, CMS included a site-neutral payment provision. With the comment period closed and the lobbying against such a provision fierce, it will be interesting to see where CMS lands in terms of the final OPPS rule: Will they maintain, change, or abate? The one thing that is for certain, regardless of the fate of this provision, is that site-neutral proposals/provisions are advancing.

Verma says drop in improper payment rate is result of “focused effort to target root causes”

Nov 20, 2018
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The Bottom Line

CMS reports that the 2018 Medicare fee-for-service improper payment rate is at its lowest since 2010. The improper payment rate is in its second year of being below the 10 percent threshold for compliance established in the Improper Payments Elimination and Recovery Act of 2010. Corrective actions made by skilled nursing facilities in particular resulted in a $1.04 billion decrease in estimated improper payments from 2017 to 2018.

Q&A from Biller’s Talk

Nov 20, 2018
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The Bottom Line

Q: This is my first time billing for the flu shots, can we add them to our Part A and Part B claims, or does it have to be a separate batch? Can you bill a roster through DDE?

A: Flu vaccines can only be reimbursed by Medicare Part B. They can be submitted via a roster or individual part b claims. You can bill a roster through DDE.

Featured member resource: HIPAA authorization form

Nov 20, 2018
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The Bottom Line

Securing resident health information should be an ongoing effort that is constantly evaluated for effectiveness. There are several widely accepted measures that facilities should implement to protect resident health information and prevent data breaches. Safeguarding residents’ health information has always been a major concern in all healthcare settings, but it has taken on added importance with the implementation of EHRs and evolving HIPAA privacy and security rules

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.

Privacy concerns for the business office

Nov 16, 2018
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The Bottom Line

The following is an excerpt from an article that originally appeared in the October 2018 issue of Briefings on HIPAA.

HIPAA permits the use and disclosure of PHI for treatment, payment, and healthcare operations (TPO). In other words, covered entities (CE) like medical providers can share PHI with other CEs and business associates in the course of conducting normal operations—to treat patients, receive payment for services, or conduct audits, quality checks, and performance management to improve healthcare operations.

Featured questions from Biller’s Talk

Nov 16, 2018
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The Bottom Line

Q: A patient came in from the hospital. The patient was admitted to Medicare Part A and was expected to stay, however after two hours, she wanted to go home and the physician ordered home health services. The patient didn’t sign the contract at the time of admission and didn’t sign an advance beneficiary notice (ABN). Does this count as a utilization day and should Medicare be billed using the AAA default rate?

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