14 key concepts 2 must know rugs payment rates for the resident in order to make decisions that will optimize reimbursement o rug iii group associated payment mds 2 0 and mds 3 0.
What is rug iv.
Resource utilization groups rugs rugs are mutually exclusive categories that reflect levels of resource need in long term care settings primarily to facilitate medicare and medicaid payment they are assigned to individuals based on data elements derived from the ltc minimum data set mds there is a standard order or hierarchy and each rug is associated with relative weighting factors rug assignments can be made on a hierarchical or an index maximization basis.
Payment is determined by categorizing patients into groups based on their care and resource needs.
Having a minimum activity of daily living adl dependency score of 2 or more.
Rug iv essentially recalibrates the rug iii in order to put more money into complex patient cases that require intensive nursing services.
The fact sheets are designed around individual topics and rug categories and can be provided individually or as a package of several based on the needs of individual resident.
Rehabilitation plus extensive services rux rul rvx rvl rhx rhl rmx rml rlx residents satisfying all of the following three conditions.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
Having a minimum activity of daily living adl dependency score of 2 or more.
Rug iv score characteristics associated with major rug iv category rehabilitation plus extensive services rux rul rvx rvl rhx rhl rmx rml rlx residents satisfying all of the following three conditions.
Ultra u 720 minutes very high v 500 719 minutes.
What is case mix who to call for case mix information case mix questions and answers requesting a reconsideration what is rehabilitation.
Only mds 3 0 and rug iv mds 2 0 with ard 10 01 2010 or later is not valid and will be rejected.
Rug iv directory of fact sheets.
Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.
Major rug iv category rug iv score characteristics associated with major rug iv category.
Receiving physical therapy occupational therapy and or speech language pathology services while a resident.
This monetary shift is accomplished by adjusting therapy group payments.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
As an example a new admission with a case mix classification of rab might be provided with a package of fact sheets that include.
In other words payments for intensive nursing care will rise while total payment for therapy groups will remain fairly constant.
