What Is Rug Iv

This method is stemming from the snf pps fy2012 final rule and was previously rug iii.

What is rug iv.

Payment is determined by categorizing patients into groups based on their care and resource needs. Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels. Rehabilitation plus extensive services rux rul rvx rvl rhx rhl rmx rml rlx residents satisfying all of the following three conditions. 14 key concepts 2 must know rugs payment rates for the resident in order to make decisions that will optimize reimbursement o rug iii group associated payment mds 2 0 and mds 3 0.

As an example a new admission with a case mix classification of rab might be provided with a package of fact sheets that include. Major rug iv category rug iv score characteristics associated with major rug iv category. Use the hierarchical classification worksheet in chapter 6 of the rai manual. 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 is associated with relative weighting factors rug assignments can be made on a hierarchical or an index maximization basis.

Rug iv classification include all minutes in individual therapy one half of the minutes in concurrent therapy although total minutes received are documented on each resident s mds and all minutes in group therapy. Only mds 3 0 and rug iv mds 2 0 with ard 10 01 2010 or later is not valid and will be rejected. The fact sheets are designed around individual topics and rug categories and can be provided individually or as a package of several based on the needs of individual resident. Rug iv directory of fact sheets.

This monetary shift is accomplished by adjusting therapy group payments. In other words payments for intensive nursing care will rise while total payment for therapy groups will remain fairly constant. Receiving physical therapy occupational therapy and or speech language pathology services while a resident. Rug iv essentially recalibrates the rug iii in order to put more money into complex patient cases that require intensive nursing services.

What is case mix who to call for case mix information case mix questions and answers requesting a reconsideration what is rehabilitation. Ultra u 720 minutes very high v 500 719 minutes. Mds 3 0 rug iv 66 category table urban adls end splits rug cmi rate 042 aids 15 16 signs of depression le2 45 412 73 941 02 15 16 no signs le1 33 345 26 787 19 11 14 signs of depression ld2 42 396 66 904 38 11 14 no signs ld1 27 332 42 757 92. Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.

Having a minimum activity of daily living adl dependency score of 2 or more.