Medicare Rug Descriptions

The centers for medicare and medicaid services cms are named in the asc x12 837 institutional claim implementation guide as the code source for hipps codes.

Medicare rug descriptions. Medicare and other payers these rug ivs are represented as the first. A capitated integrated medicaid and medicare managed care program that in addition to the family care long term care benefits provides managed health care benefits and all applicable medicare advantage special needs plan and medicare part d prescription drug benefits. Medicare advantage 1876 cost or pace plans typically waive the 3 day hospitalization requirement. 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.

Partnership is the wisconsin family care partnership program. Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies. 1 definition and uses of health insurance prospective payment www cms gov. Jan 3 2010 made using one of 66 resource utilization groups version iv rug iv.

Use the hierarchical classification worksheet in chapter 6 of the rai manual. The rug iv classification system includes eight major classification categories. 4 8 rua 16 18 rvc 9 15 rvb. This page contains information related to the use and maintenance of the health insurance prospective payment system hipps codeset.

Each ma plan s evidence of coverage. While ma plans must cover the same number of snf days available under original medicare they may cover more snf days than original medicare. In addition ma plans may have different benefit periods. Having a minimum activity of daily living adl dependency score of 2 or more.

Rug 44 rug 53 distribution chart based on cy 2006 data is available for download from the downloads section below. A week minimum at least 2 disciplines 1 discipline 5 days 2nd at least 3 days. The rug iv classification system includes eight major classification categories. 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.

Rug iv classifications help medicare determine the part a snf pps payment. Report to congress on patient classification under medicare s prospective payment system for skilled nursing facilities 2006 dr. Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.