Rug Reimbursement Categories

An initial set of rugs developed primarily to support resource risk adjustment for medicaid payment reflects 7 major categories of care.

Rug reimbursement categories.

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. Volume is from jul. Hospital based clinics er s observation and ambulatory surgery. Nursing facility case mix payment changes medicaid gov.

The pps is the ambulatory payment classification system apc included in this payment category are. Rug iv categories and characteristics 1 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. The rug determines the facilities reimbursement rate. And reduced physical functioning 10.

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. Encounter bases classification system. Both the standard medicare part a rug reported in item z0100a and the medicare part a non therapy rug in item z0150a are recorded on the mds 3 0. Nursing facility provider reimbursement rule tn gov.

Rug rates are for 2017. This group includes very heavy care patients i e their functional level is on the whole very low. 6 dec 2018 centers for medicare medicaid services on october 1 2020 cms will no longer support rug iii and rug iv case mix methodologies. 1 jul 2018.

Having a minimum activity of daily living adl dependency score of 2 or more. To obtain a non therapy rug with this worksheet skip category i rehabilitation plus extensive services and category ii rehabilitation and start with category iii extensive services. Leadingageny analysis of medicaid claims data options continued 8 while there are 16 rug categories and regions the alp resident population tends to fall within one of 5 6 rug groups. Coma quadriplegia multiple sclerosis stage 4 decubiti nasal gastric feeding parenteral feeding suctioning.

Separating the rug iv base rates into.