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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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.

Did you miss our most recent Billers’ Association for Long-Term Care webinar?

Jan 18, 2019
 | 
The Bottom Line

Our speakers put on a great presentation this Wednesday with lots of helpful regulatory updates, including updates to the MDS, flu vaccination codes for 2019, and a walkthrough of how to use the new FISS/DDE search features. We also covered the SNF Value-Based Purchasing Program and how the new measures will affect facilities Medicare rates. If you missed the live show, you can listen to the recording here. Don’t forget to sign up for other webinars throughout the year on our webinar registration page

Chief compliance officer job description, competencies, and performance evaluation

Jan 18, 2019
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The Bottom Line

By now, most organizations have identified a compliance officer, set up a reporting hotline for staff to report concerns, and done some training with staff on the elements of their facility’s specific compliance and ethics plan to meet the November 28, 2019 implementation deadline.

Having a trusted and responsible person that reports directly to the governing board is imperative to the success of a compliance and ethics program. The compliance officer is responsible for overseeing all aspects of the implementation of the program and reporting its progress on a regular basis to senior management. This individual is also primarily responsible for evaluating the program’s needs and tailoring the tools required of a compliance and ethics program to best meet those in a timely manner. Download our Chief Compliance Officer Job Description, Competencies, and Performance Evaluation to help this role measure his or her success.

What are SNF billers talking about this month?

Jan 18, 2019
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Billing Alert for Long-Term Care

The following Q&A comes from the Billers' Association for Long-Term Care talk forum, Biller's Talk.

Q: Is the facility required to give a Notice of Medicare Non-Coverage (NOMNC) to a benefit-exhausted resident?

A: An NOMNC is not required by CMS regulation to be issued in relation to benefit exhaust; however, it is not wrong or held against a facility to issue one at that time. Some organizations with multiple facilities require the NOMNC to be issued as a best practice and as part of their policy and procedures, even in the event that the Medicare Part A services are terminated due to benefit exhaust.

The regulations regarding NOMNCs can be found at CMS.gov in the Medicare Claims Processing Manual, Chapter 30, Section 260.

Don’t forget to register for next week’s webcast!

Jan 11, 2019
 | 
The Bottom Line

On Wednesday, January 16, 12:00pm – 1:00pm, ET, BALTC members are invited to join our quarterly webcast. The presentation will begin with a few membership update announcements from director of content, Brianna Shipley, followed by some important regulatory updates presented by HCPro’s post-acute regulatory specialist, Stefanie Corbett, DHA. Finally, BALTC advisory board member and senior consultant for LW Consulting, Jennifer Matoushek, MBA/HCM, CPC, will explain to listeners how the SNF Value-Based Purchasing Program can affect their Medicare rates, as well as an overview of what to expect from the program in 2019. After the presentation, audience members will be able to submit questions of our speakers.

Register here and don’t forget to pack a lunch!

Triple check monthly billing review

Jan 11, 2019
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The Bottom Line

Implementing a triple check process in your facility not only helps improve therapy and nursing documentation, but can also assist in monitoring and identifying areas of discrepancy and opportunity to improve the management of the Medicare Part A process. Performing a monthly billing review can help ensure that critical elements are present on the MDS to ensure optimum payment. Download our triple check monthly billing review tool to keep each item organized and tracked.

Reminder to pharmacies for correctly billing Part B claims using KX modifier for immunosuppressive drugs

Jan 11, 2019
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The Bottom Line

In response to a 2017 OIG report noting that some pharmacies billed Medicare incorrectly for Part B claims using the KX modifier for immunosuppressive drugs, CMS has published several resources to clarify manual instructions and help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources include the following:

Don’t let your HIPAA policies and procedures go stale

Jan 11, 2019
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Billing Alert for Long-Term Care

For HIPAA covered entities (CE) that maintain poor policies and procedures related to HIPAA compliance—those that are unfinished in draft form, not updated in years, and basically not followed to the letter—their lassitude has cost them dearly.

Just look at some of the settlements OCR has struck with CEs and business associates (BA) in the past five years. Many of those settlements include findings that organizations had poorly maintained policies and procedures. This has increased the settlement amounts and in turn led OCR to issue strict consent decrees requiring these entities to update and maintain their HIPAA-related policies and procedures.

What you need to know about the updated MDS items sets for 2019

Jan 11, 2019
 | 
The Bottom Line

CMS posted a new DRAFT version of the 2019 MDS item sets (v1.17.0) last week. This version is scheduled to become effective October 1, 2019, giving facilities until then to update their software with the new MDS questions and answers. Downloadable files can be accessed here: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30TechnicalInformation.html

HCPro’s post-acute regulatory specialist Stefanie Corbett, DHA, reports the following changes.

Words on the street: Acronyms of PDPM

Jan 04, 2019
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Billing Alert for Long-Term Care

When the Centers for Medicare & Medicaid Services’ (CMS) new Patient Driven Payment Model (PDPM) goes into effect October 1, 2019, providers will have a few new acronyms to add to their dictionary, as well as some old ones that will have increased importance to quality care and reimbursement. The following list and words of advice from experts will will help you prepare.

ARD—Assessment reference date

The assessment schedule under PDPM is more streamlined and simplified than the assessment schedule under RUG-IV. The assessment reference dates are listed in Table 1 for the different Medicare MDS assessment types.

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