Understanding Rug Iv

Rug iv essentially recalibrates the rug iii in order to put more money into complex patient cases that require intensive nursing services.

Understanding rug iv. Payment is determined by categorizing patients into groups based on their care and resource needs. Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions. Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies. The aim of the rug refinement is to improve the ability of the existing rug iii classification system to explain non therapy ancillary nta costs.

In other words payments for intensive nursing care will rise while total payment for therapy groups will remain fairly constant. These codes are effective as of october 1 2020. Brant fries 2003 using data from our 2001 analysis files and replicated and validated the research. Individual concurrent and group.

Having a minimum activity of daily living adl dependency score of 2 or more. This method is stemming from the snf pps fy2012 final rule and was previously rug iii. The urban institute re examined prior efforts by abt associates 2000 and dr. Rugs iv the new rugs iv case mix classification system is based on results of ongoing analysis of nursing home staff time measurement stm data collected in the staff time and resource intensity verification strive project.

Spotlight the fy 2021 pdpm icd 10 mappings zip have been updated to reflect non substantive updates to the icd 10 code set for fy 2021 as well as substantive changes finalized in the fy 2021 snf pps final rule. This monetary shift is accomplished by adjusting therapy group payments. Updates to the value based. Prospective payment system and consolidated billing for skilled nursing facilities.

Rug iv coding requires the therapist to specifically account for the time captured within the look back period utilizing the three recognized formats. 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. 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.

The worksheet takes the grouper logic and puts it into words. There will be an additional 13 rugs increasing the total number from 53 to 66 see appendix a.