Welcome to The Billers' Association For Long-Term Care

The Billers’ Association for Long-Term Care (BALTC) is a membership community created specifically for professionals involved in the long-term care revenue cycle. This national association provides members with a resource of continuously updated tools, reimbursement and regulatory guidance, and education to help prevent revenue loss and documentation and billing errors so providers can withstand audits at any point in time. With its involved expert advisory board members and active talk group, this engaged group of professionals is a great place for sharing and receiving best practices, tips, and tools with your peers.

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New Medicare cards: What’s that square code?

June 22, 2018
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The Bottom Line

CMS published an announcement explaining that some of the new Medicare cards may have a square code, also referred to as a QR code (a type of machine-readable code).

“The QR codes on Medicare cards allow the contractor who prints the cards to ensure the right card goes to the right person with Medicare or Railroad Retirement Board (RRB) benefits. Providers cannot use it for any other purpose. The RRB issued cards may have a QR code on the front of the card while all other Medicare patients may get a new card with a QR code on the back of the cards. These are legitimate (official) Medicare cards,” says the announcement.

A tool for your CNAs to help with accurate ADL documentation

June 22, 2018
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The Bottom Line

The SNF PPS establishes a schedule of Medicare assessments, and each assessment supports reimbursement. These scheduled assessments establish per diem payment rates for associated standard payment periods. A very important element that feeds PPS reimbursement is the measurement of the level of independence each resident has in activities of daily living (ADLs) for the late-loss ADLs: bed mobility, transfer, toilet use, and eating. Each is a cost center category, and it becomes highly important that certified nursing assistants/geriatric nursing assistants, who typically perform these observations and tasks, understand the need to accurately document the level of assistance provided to the resident.

CMS issues guidance for handling insufficient documentation, ADRs

June 22, 2018
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The Bottom Line

CMS issued change request (CR) 10778 on June 15, with an effective date of July 17, to update Chapter 12 of the Medicare Program Integrity Manual. The proposed update includes details for handling non-responders and insufficient responses to additional documentation requests (ADR) under the Comprehensive Error Rate Testing (CERT) program.

Reimbursement increased by 77% for brand-name Part D drugs

June 15, 2018
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The Bottom Line

According to a report published by the OIG this month, total reimbursement for all brand-name drugs in Part D increased 77% from 2011 to 2015, despite a 17% decrease in the number of prescriptions for these drugs. After accounting for manufacturer rebates, reimbursement for brand-name drugs in Part D was found to have still increased 62% from 2011 to 2015.

What should your policy for coding compliance and ethics include?

June 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.

What are you doing in August?

June 8, 2018
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The Bottom Line

Join us in Chicago on Monday and Tuesday, August 13-14, to attend our SNF Regulatory Update Boot Camp! This event covers the industry changes that impact your clinical and financial operations while providing strategies for achieving and sustaining compliance in the future marketplace. Attendees can expect to learn best practices for leading and managing facilities to avoid survey issues, claims audits, and improper Medicare payments.

SNF provider preview reports now available, review before June 30

June 7, 2018
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The Bottom Line

Skilled Nursing Facility (SNF) Provider Preview Reports have been updated and are now available. Providers have until June 30, 2018 to review their performance data prior to public display on the Nursing Home Compare site. Corrections to the underlying data will not be permitted during this time. However, providers can request a CMS review during the preview period if they believe their data scores displayed are inaccurate.

Proposed payment rule PDPM: What SNFs need to know

June 1, 2018
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The Bottom Line

The Patient-Driven Payment Model (PDPM), as proposed, is designed to replace the current SNF payment methodology known as RUG-IV. Unless date changes, etc. are made by CMS post commentary review, the effective date of the change (from resource utilization groups to PDPM) is October 1, 2019. PDPM as an outgrowth of the initially proposed resident classification system (RCS) and received commentary is a simplified payment model designed to be more holistic in patient assessment, capture more clinical complexity, eliminate or greatly reduce the therapy focus by eliminating the minute levels for categorization, and simplifying the assessment process and schedule (reducing to three possible assessments/MDS tasks). Below is a summary of PDPM core attributes/features as proposed. Click here to access the PDPM Calculation Worksheet for SNFs that provides additional details beyond the reference points below.

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