Guide to manually determine the appropriate rug iv classification based on the responses from the mds assessment.
Rug iv classification system 66 group.
Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.
Scope in the rug iv 48 group model compared to the rug iv 66 medicare group model the rehabilitation.
Prospective payment system and consolidated billing for skilled nursing facilities.
Rug assignments weights are applied at the individual level but the average relative risk of a facility s residents is typically used to adjust the nursing components of state medicaid payment systems one exception.
Pt group ot individual 75 78 80 52 75 ot concurrent ot group st individual st concurrent st group 2.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
Use the hierarchical classification worksheet in chapter 6 of the rai manual.
Logic version 1 03 and code version 1 03 0 july 18 2013 rca rug classification.
The purpose of this rug iv version 1 00 calculation worksheet for the 66 group model is to provide a step by step walk through to manually determine the appropriate rug iv classification based on the data from an mds assessment.
These codes are effective as of october 1 2020.
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.
Pdpm is a case mix group cmg reimbursement method that focuses on clinically relevant factors rather than volume.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
Rug iv categories and characteristics 1 major rug iv.
This guide takes the standard grouper logic and puts it into a readable format.
The urban institute re examined prior efforts by abt associates 2000 and dr.
Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 rug iv grouper overview.
Mds 3 0 rug iv 66 category table urban adls end splits rug cmi rate 042 aids 11 16 not used rux 66 737 08 1 680 54 2 10 not used rul 65 721 01 1 643 90 11 16 not used rvx 63 656 06 1 495 82 2 10 not used rvl 61 588 60 1 342 01.
Updates to the value based.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
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.
