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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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.

Achieve accurate reimbursement and compliance with these best practices

Nov 09, 2018
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Billing Alert for Long-Term Care

A best practice is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. In any industry, best practices are developed over time. Professionals involved in the revenue cycle of a long-term care (LTC) facility must have a solid understanding of the fundamentals of claims processing as they relate to the Medicare regulations and the facility’s state Medicaid reimbursement system.

Providers worry that proposed rule could cut Medicaid revenue

Nov 09, 2018
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The Bottom Line

The CMS is drafting a proposed rule that would give states greater flexibility in paying (or not paying) for non-emergent medical transportation (NEMT) for Medicaid beneficiaries. This proposed rule aligns with CMS’ repeated intentions to create “a new era for the federal and state Medicaid partnership where states have more freedom to design programs that meet the spectrum of diverse needs of their Medicaid population,” as stated in a letter from HHS secretary Tom Price and CMS administrator Seema Vera earlier this year.

Healthcare winners and losers from election night 2018

Nov 09, 2018
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The Bottom Line

Source: HealthLeaders

The 2018 midterm elections are over but made a significant impact on healthcare policies at the federal and state level across the country, while also determining who will be in office to enact them. The future of healthcare policymaking will be influenced by the decisions made by millions of voters on Tuesday night, as Democrats took back the House while Republicans held onto control in the Senate. Healthcare was a top priority for voters as they made their way to the polls to vote on issues such as Medicaid expansion and the healthcare leaders seeking to represent them on Capitol Hill.

Featured member resource: MDS chart audit tool

Nov 09, 2018
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The Bottom Line

The purpose of the MDS chart audit tool is to ensure documentation is present in the medical record to support the findings of the MDS. Use the tool at the end of the month or the episode of care. If documentation that supports the MDS is present for each item, place a checkmark. If it is not, highlight the area so it can be followed up on to ensure completeness. This form can be completed by the MDS coordinator, DON, medical records, therapy director, or delegated per area of specialty. Download this Billers’ Association for LTC member resource.

 

Reducing accounts receivable and improving collections: A success story

Nov 02, 2018
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Billing Alert for Long-Term Care

Deborah Collum, national director of revenue cycle management for Covenant Retirement Communities in Skokie, Illinois, uses one word to prepare people for how they’ll feel during their company’s first monthly accounts receivable (AR) meeting: naked.

“When my company first started conducting AR meetings, they were an hour and a half long, but now we’ve pared them down to about 20 minutes because our AR is so clean. You have to identify the ugly before you can get to the pretty,” she says.

These 7 readmission risks could prevent you from receiving SNF VBP incentive payments

Nov 02, 2018
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The Bottom Line

As of October 1, 2018, the Skilled Nursing Facility (SNF) Value-Based Purchasing Program (VBP) rewards SNFs with incentive payments for reducing hospital readmissions. To receive incentive payments for this quality measure, make sure these 7 readmission risks don’t exist in your facility.

CMS final rule makes changes to how physicians are paid, delays E/M coding reform

Nov 02, 2018
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The Bottom Line

As part of a final rule published by CMS yesterday to reduce provider burnout, the implementation of coding reforms for physician services known as “Evaluation and Management” (E/M) visits--requirements that haven’t been updated in 20 years--were delayed until 2020 to allow for continued stakeholder engagement. For CY 2019 and CY 2020, CMS will continue the current coding and payment structure for E/M office/outpatient visits and practitioners should continue to use either the 1995 or 1997 E/M documentation guidelines to document E/M office/outpatient visits billed to Medicare, according to a CMS fact sheet. Additional policies for CY2019 and beyond are listed in the fact sheet.

The RACs’ role in identifying over- and underpayments

Oct 26, 2018
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Billing Alert for Long-Term Care

The Recovery Audit Program’s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of healthcare services provided to Medicare beneficiaries and the identification of underpayments to providers; by doing so, the Centers for Medicare & Medicaid Services (CMS) can implement actions that will prevent future improper payments in all 50 states.

New white paper available

Oct 26, 2018
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The Bottom Line

Download The Billers’ Association fourth quarter white paper: An in-depth look at how reimbursement is calculated under PDPM. Stefanie Corbett, DHA, post-acute regulatory specialist for HCPro breaks down tables and guidance from the final rule and PDPM calculation worksheet and provides a step-by-step guide to understanding the new payment model. Peruse this and previous year’s white papers on The Billers’ Association resources page. Have an idea for a topic you’d like to see? Write me at bshipley@hcpro.com.

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