Harmony Healthcare Blog

Medicare Rehabilitation Medium and Low RUG Categories - Distinct Days

Posted by Kris Mastrangelo on Tue, Dec 10, 2013

CMS released the Final Rule in August 2013 solidifying the changes to the calculation for classification into the Medicare Rehabilitation Medium and Low RUG categories for RUG-IV. The changes began with assessment dates with an ARD on or after October 1, 2013.

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Topics: CMS, MDS 3.0, RUG-IV;

Scrutinize the Lower 14 RUG-IV Scores

Posted by Kris Mastrangelo on Tue, Aug 13, 2013

May 12, 1998, the Interim Final Rule was published presenting the SNF PPS (Prospective Payment System).  It turned the industry upside down.  Away with the retrospective cost based system.  Away with certified distinct parts, time studies and weighing of the laundry.  Instead, a MDS based payment system which touted reimbursement for resources (the higher the resources, the higher the rate of reimbursement).  Within this model, there were 44 RUG levels, of which the top 26 were deemed “automatically skilled” while the lower 18 levels were “at risk for audit”.   This was a proxy for the original criterion for skilled coverage (Management of Care Plan, Observation and Assessment, Teaching and Training and the nursing/therapy skills with inherent complexity).   Medicare days plummeted across the country.  Multiple nursing home chains declared bankruptcy.  Why?  Nobody understood the system and patients were readily denied benefits solely based on the MDS RUG score….even when the score was incorrectly coded.  Within 18 months, the BIPA (Beneficiary and Improvement Protection Act) revised this error and the original coverage criterion was reinstated.  

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Topics: RUG-IV;

CMS Provider Trainining Discusses MDS and RUG-IV Changes

Posted by Peter Mastrangelo on Thu, Mar 22, 2012

CMS Provider Training Recommendations - Medicare Minute

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Topics: CMS, ARD, MDS, MDS 3.0, RUG-IV;

Revenue Isulation, Documentation and RUG-IV

Posted by Peter Mastrangelo on Thu, Jul 14, 2011

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Topics: Medicare, Medicaid, MDS 3.0, RUG-IV;

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