Understanding Therapy Rug Levels

Ultra high we based this study on an analysis of paid part a snf claims from the.

Understanding therapy rug levels. Ultra u 720 minutes. With rug iii it was the upper 35 rug scores and under rug iv it will be the upper 52 rug scores. The resident received a level of rehabilitation therapy to qualify for an ultra high very high high medium or low rehabilitation rug iv category. Residents receiving physical therapy occupational therapy and or speech language pathology services while a resident.

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. 2 disciplines one 5days. 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. The highest of the five rehabilitation rug levels ultra high requires at least 720 therapy minutes per week followed by very high at least 500 minutes.

Skilled nursing facility billing for changes in therapy oig hhs gov. The urban institute re examined prior efforts by abt associates 2000 and dr. There is a concurrent expansion of the level of care presumption. Mds 3 rug 53 groups.

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 changes to such a degree that it would no longer reflect the rug iv classification and payment assigned based on the most recent assessment used for. Ultra u 720 minutes very high v 500 719 minutes high h 325 499 minutes medium m 150 324 minutes low l 45 149 minutes while a resident receiving complex clinical care and have needs involving tracheostomy care ventilator respirator and or infection isolation. Minimum data set supportive documentation guidelines rug iii version 5 12 34 grouper june 1 2012. 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.

Mds 3 rug iii version 5 12 44 grouper. 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. These thresholds are minimum requirements and medicare rules clearly state that if the rehabilitation professional and attending physician agree that the patient needs additional minutes the facility must arrange and pay for them. Brant fries 2003 using data from our 2001 analysis files and replicated and validated the research.

Jun 5 2015 the particular rug determines how much medicare pays each day for the the therapy rugs are divided into five levels of therapy. The new format has 23 different rehab plus extensive services and rehab groups representing 10 different levels of rehabilitation.