This monetary shift is accomplished by adjusting therapy group payments.
What is rug iv.
Payment is determined by categorizing patients into groups based on their care and resource needs.
Rug iv essentially recalibrates the rug iii in order to put more money into complex patient cases that require intensive nursing services.
As an example a new admission with a case mix classification of rab might be provided with a package of fact sheets that include.
What is case mix who to call for case mix information case mix questions and answers requesting a reconsideration what is rehabilitation.
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.
Use the hierarchical classification worksheet in chapter 6 of the rai manual.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
Only mds 3 0 and rug iv mds 2 0 with ard 10 01 2010 or later is not valid and will be rejected.
Having a minimum activity of daily living adl dependency score of 2 or more.
Rug iv classification include all minutes in individual therapy one half of the minutes in concurrent therapy although total minutes received are documented on each resident s mds and all minutes in group therapy.
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.
Receiving physical therapy occupational therapy and or speech language pathology services while a resident.
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.
Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.
Rug iv directory of fact sheets.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
Rehabilitation plus extensive services rux rul rvx rvl rhx rhl rmx rml rlx residents satisfying all of the following three conditions.
In other words payments for intensive nursing care will rise while total payment for therapy groups will remain fairly constant.
Having a minimum activity of daily living adl dependency score of 2 or more.
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.
