Payment is determined by categorizing patients into groups based on their care and resource needs.
Rugs iv classification system.
Resident qualifies as depressed yes no rug iv adl score depressed rug iv class 15 16 yes he2 15 16 no he1.
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.
2018 rai user s manual and mds coding updates objectives.
Oct 2 2018 decision by reading the chart.
The current worksheet was developed for the hierarchical methodology.
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.
1 hierarchical classification and 2 index maximizing classification.
There are two basic approaches to rug iv classification.
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.
Instructions for adapting this worksheet to the index maximizing approach are included below see index maximizing classification.
For rug iv classification in either of the two following cases.
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.
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.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
The guide also includes the calculation to determine the resident s late loss adl score.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
Use the hierarchical classification worksheet in chapter 6 of the rai manual.
Logic version 1 03 and code version 1 03 0 july 18 2013.
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.
