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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Did you miss our quarterly webinar? Here’s how to listen.

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The Bottom Line

If you couldn’t attend the Billers’ Association for Long-Term Care’s quarterly webinar earlier this month, here’s what you missed! Click here to access the recording. Postacute regulatory specialist for HCPro, Stefanie Corbett, DHA, reviewed current regulatory updates and what they mean for SNF reimbursement, including the flu vaccine payment allowance and code updates, the latest changes to the MDS effective October 1, 2018, and a reminder of reporting requirements for the SNF QRP and VBP.

Are you billing Occurrence Code 22 correctly?

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The Bottom Line

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim.

Trump administration’s proposed rule aims to penalize legal immigrants for using Medicaid

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The Bottom Line

The Trump administration’s proposed rule issued on Wednesday raises concerns about the health of public health efforts and threatens healthcare, nutrition, and housing assistance for millions of low-income legal immigrant families. The proposal, published in the Federal Register by the Department of Homeland Security, would allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition and other programs as a strongly negative factor in their applications for legal permanent residency, reports Modern Healthcare.

CMS publishes 2016 SNF PUF data

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The Bottom Line

CMS has posted the fourth release of the Skilled Nursing Facility Public Use File (Skilled Nursing Facility PUF) with data for 2016. The Skilled Nursing Facility PUF presents summarized information on services provided to Medicare beneficiaries by skilled nursing facilities. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. 

CMS publishes corrections to RUG-IV federal per diem rates & MDS item in SNF PPS final rule

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The Bottom Line

The Centers for Medicare & Medicaid Services published the following summary of errors published in the FY2019 SNF PPS final rule. The correction to these errors are found in Section IV of the correction notice and are effective October 1, 2018. CMS also republished the wage indexes in Table A and B on the CMS website to at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html to correct errors made there.

Your Medicare Advantage plan may be inappropriately denying payments

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The Bottom Line

Medicare Advantage Organizations (MAO) may be gaming the capitated payment model to increase their profits, an Office of Inspector General (OIG) report suggested. The September 25 report details an OIG study undertaken to address concerns that MAOs are inappropriately denying authorization of services for beneficiaries or payments to providers.

CMS invites Medicare Part A providers to learn new Medicare Cost Report e-filing system

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The Bottom Line

Register for Medicare Learning Network events. Medicare Part A providers: Learn how to use the new Medicare Cost Report e-Filing (MCReF) system. Use MCReF to submit cost reports with fiscal years ending on or after December 31, 2017. You have the option to electronically transmit your cost report through MCReF or mail or hand deliver it to your Medicare Administrative Contractor. You must use MCReF if you choose electronic submission of your cost report. For more information, see the MCReF MLN Matters Article and MCReF webpage.

New HCPCS code, Q5110, effective October 1, 2018

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The Bottom Line

A revised MLN Matters article regarding updated healthcare common procedure coding system (HCPCS) drug/biological code changes deleted the note that stated MACs should hold claims for HCPCS codes Q5108 and Q5110 until CR10834 is implemented, since that is no longer a requirement. The article was originally released on August 10, 2018 and revised on September 13, 2018.

Updates to MDS 3.0 FY2019

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The Bottom Line

Changes to the Minimum Data Set (MDS) for skilled nursing facilities (SNFs) for the fiscal year 2019 include mechanical fixes (i.e. grammar, punctuation, capitalization, and text updates), clarifications and new items. Want a hard copy of this best-selling MDS 3.0 RAI User’s Manual? Check out HCPro’s version published with the latest updates on September 19, 2018. Facilities should prepare for the updates to the following sections effective October 1, 2018.

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