Therapy Rug Levels

Minimum data set supportive documentation guidelines rug iii version 5 12 34 grouper june 1 2012.

Therapy rug levels. Receiving physical therapy occupational therapy and or speech language pathology services while a resident. Mds 3 rug 53 groups. Under the old system rug iv there were two case mix adjusted components. In addition the rug iv grouper will only calculate a rehabilitation medium rug category when 150 minutes of therapy is provided across 5 distinct calendar days.

What levels of reduction if any will trigger audits by cms and what will those audits look like. Performance coding level definitions before using the algorithm. In other words within the 7 day observation period of the mds or cot review therapists must deliver services to the patient on at least 5 of the 7 days in the observation period from. The resident received a level of rehabilitation therapy to qualify for an ultra high very high high medium or low rehabilitation rug iv category.

Rug iv classification system 66 group with medicare case mix indices for 10 1 2010. 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. Stop at the first code. Rug iv categories and characteristics 1 major rug iv category 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.

Mds 3 0 rug iv 66 category table urban adls end splits rug cmi rate 042 aids 15 16 signs of depression le2 45 412 73 941 02 15 16 no signs le1 33 345 26 787 19 11 14 signs of depression ld2 42 396 66 904 38 11 14 no signs ld1 27 332 42 757 92. The intensity of therapy as indicated by the total reimbursable therapy minutes delivered and other therapy qualifiers such as the number of therapy days and disciplines providing therapy. Therapy based on volume of services or non case mix base rate nursing does not reflect variations in non therapy ancillary use pdpm classifies patients into a separate group for each of the five case mix index cmi adjusted components. To obtain a non therapy rug with this worksheet skip category i rehabilitation plus extensive services and category ii rehabilitation and start with category iii extensive services.

Rug iii version 5 2 calculator worksheet 34 group model. The non therapy classification uses all the rug iv payment items except the rehabilitation therapy items o0400a b c to determine a non therapy clinical rug. These are all questions that have come up early in the transition to pdpm but it s too early to assess the changes concretely.