Payment is determined by categorizing patients into groups based on their care and resource needs.
Rugs iv classification system.
The current worksheet was developed for the hierarchical methodology.
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.
Oct 2 2018 decision by reading the chart.
Use the hierarchical classification worksheet in chapter 6 of the rai manual.
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.
Category i extensive services while a resident.
1 hierarchical classification and 2 index maximizing classification.
The guide also includes the calculation to determine the resident s late loss adl score.
Having a minimum activity of daily living adl dependency score of 2 or more.
Logic version 1 03 and code version 1 03 0 july 18 2013.
2018 rai user s manual and mds coding updates objectives.
There are two basic approaches to rug iv 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.
For rug iv classification in either of the two following cases.
Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions.
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.
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.
Instructions for adapting this worksheet to the index maximizing approach are included below see index maximizing classification.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
Resident qualifies as depressed yes no rug iv adl score depressed rug iv class 15 16 yes he2 15 16 no he1.
