Medicare Part A RUGS

A Medicare Risk and Revenue Analysis (RUG Analysis) is an in-depth review of a SNF’s historic RUG utilization over a period of several months.

Viewing and trending data over time allows Harmony Healthcare International (HHI) to deep dive into the clinical trends that drive daily rates and monthly Medicare Revenue. A Harmony Healthcare International (HHI) Medicare Risk and Revenue Analysis (RUG Analysis) will also compare your facility’s utilization against the most current National CMS data. It is through a thorough review of data that Harmony Healthcare International (HHI) can devise customized and focused recommendations that can impact the areas preventing your SNF from excelling, while at the same time, minimizing risk of exposure from governmental audits.

Our HealthCARE Specialists help develop patient-specific Proper Reimbursement Explanation Paper (PREP) letters. These letters detail, describe and reference the rationale for skilled services and enhance the reviewer's understanding and justification of services provided. While completing the above process, Harmony Healthcare International (HHI) simultaneously identifies possible risk areas and causes for review. At this time, prevention strategies can be implemented at the provider level.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) can assist with the following:

  • Comprehensive, detailed breakdown of Medicare Part A Revenue into key reimbursement components
  • Revenue Analysis which details ADL splits, therapy and non-therapy RUG components and recommendations to ensure accurate and appropriate reimbursement
  • Track utilization and revenue trends against national and state averages for a defined period of time to gauge changes, aberrances and compliance triggers
  • Guide your facility to overcome the barriers preventing achievement of accurate revenue potential
  • An assessment of compliance risk, based on recent OIG reports and CMS directives
  • Provide education and training on all components to ensure accurate and appropriate reimbursement
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