Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.
Rugs iv classification system.
Oct 2 2018 decision by reading the chart.
In may 2017 cms released an advanced notice of proposed rulemaking anprm which outlined a new case mix model the resident classification system version i rcs i that would be used to replace the existing rug iv case mix model used to classify residents in a covered part a stay into payment groups under the snf pps.
Rapid rug iv guide 48 group classification the rapid rug iv guide is intended to be an at a glance reference providing the mds 3 0 items and criteria for each rug category.
For rug iv classification in either of the two following cases.
The current worksheet was developed for the hierarchical methodology.
Category i extensive services while a resident.
Having a minimum activity of daily living adl dependency score of 2 or more.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
Instructions for adapting this worksheet to the index maximizing approach are included below see index maximizing classification.
Program rug iv case mix classification system reflected the data collected in changes to the guidelines for medicare level of care determinations gg assessment items and urged cms to map missing values to a.
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.
The guide also includes the calculation to determine the resident s late loss adl score.
There are two basic approaches to rug iv classification.
Resident qualifies as depressed yes no rug iv adl score depressed rug iv class 15 16 yes he2 15 16 no he1.
The d0300 total severity score is greater than or equal to 10 but not 99 or the d0600 total severity score is greater than or equal to 10.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
1 hierarchical classification and 2 index maximizing classification.
Rug iv cheat sheet rug iv classification system 66 group with medicare case mix indices for 10 1 2010 rug iv grouper overview.
2018 rai user s manual and mds coding updates objectives.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
Payment is determined by categorizing patients into groups based on their care and resource needs.
