Pdpm is a case mix group cmg reimbursement method that focuses on clinically relevant factors rather than volume based services or rug iv codes.
Rugs iv codes.
Effective october 1 2017 excel.
Major rug group rug code hierarchical classification adl score case mix index set e01 rural.
It improves payment accuracy and appropriateness by focusing on the patient rather than the volume of services provided.
The worksheet takes the grouper logic.
Hipps code master list see file below an excel spreadsheet that provides a complete list of all valid hipps codes with their effective dates payment settings and code definitions.
Rug iv 66 group model calculation worksheet for snfs page 1 of 29 october 12 2010 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.
The 5 digit hipps code includes two components.
The attached file contains the list of the newly added hipps codes.
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.
Code for the most support provided over all shifts.
Code regardless of resident s self performance classification level of support.
Access the listings of resource utilization groups rugs for skilled nursing facilities snfs from the links below.
The case mix index columns contain integer rankings of the rug codes based on the total medicare r ate and are used for medicare snf pps rug iv index maximized classification.
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.
Effective october 1 2014 excel.
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.
Due to rounding a slight variance may exist between the spreadsheets below and actual medicare payments.
The 3 digit classification code assigned to each rug group and newly defined 2 digit assessment.
Change request process see file below describes the steps necessary to request a modification in the hipps codeset and the cms code approval process.
This instruction contains new hipps codes resulting from the conversion to the new rug iv coding system.
Effective october 1 2015 excel.
