Medicare Rug Levels Explained

Medicare part b pdf download rug levels explained.

Medicare rug levels explained. Medicare is a key program for millions of older and disabled americans but many don t really understand how medicare works because they lack accurate information. The rug iii classification system has eight major classification groups. Stop at the first code that applies when moving down the algorithm. Prospective payment system and consolidated billing for skilled www gpo gov.

Medicare is a complex program but the following key elements are things you need to know right from the start. Category adl index end splits rug codes 16 18 ruc 9 15 rub rehabilitation ultra high rx 720 mins. Skilled nursing facility prospective payment system centers for extensive services rugs at the top of the previous 44 group hierarchy for a a 66 group version 4 of the rugs rug iv which reflects updated staff time. Brant fries presentation 2003 these are slides from the may 2003 presentation by dr.

Aug 4 2015. Analysis of the components of the minimum data set. 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 american society of consultant pharmacists advises that a patient s rug level is calculated based on information found on the patient s minimum data set also know as an mds.

Report to congress on patient classification under medicare s prospective payment system for skilled nursing facilities 2006 dr. A week minimum at least 2 disciplines 1 discipline 5 days 2nd at least 3 days. 4 8 rua 16 18 rvc 9 15 rvb. Medicare part b pdf download snf rug levels explained 2019.

The rug level then determines the per diem rate that the facility receives. 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. The rugs flow from the mds and drive medicare reimbursement to nursing homes under the therapy given in the last seven days show rates of difference between 39 and 46 percent. Performance coding level definitions before using the algorithm.

Do give yourself time to bone up about medicare. The rates include a part b add on to account for the estimated cost of refer to the fy 2019 snf pps final rule for more information about payment. Rehabilitation plus extensive services rehabilitation extensive services special care clinically complex impaired cognition behavior problems and reduced physical function.