On July 31, 2016, CMS announced that the payment levels currently used in the prospective payment system (PPS), resource utilization group (RUG) IV, will be replaced in FY2019 by the resident classification system (RCS-1). This replacement is currently scheduled to be implemented by October 2018.
This will be a complicated and significant change for providers. The majority of the changes that will occur with the implementation of RCS-1 are based on claims history and MDS data submitted. In order to understand and prepare for this shift, providers will need to learn how to achieve quality outcomes and higher reimbursement under a system that will offer different incentives.
“Long-term care facilities should educate their rehab directors, MDS staff, finance staff involved in budgeting, billing staff, and case managers,” explained Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, president of Celtic Consulting, LLC during her 90-minute webinar “Goodbye RUG-IV, Hello RCS-1: How to Achieve Quality Outcomes Under a New Payment System.” (Miss the live show? Buy the on-demand version here!)
“If staff nurses complete the MDS, they will also need to be educated on the new process and payment levels. As a former director of skilled nursing, I would expect to be included as well since the change affects nursing operations. Administration and owners should be aware of the changes as well,” says McCarthy.
HCPRO is following this change closely and will continue to provide updates, guidance, tools, and resources to help you stay informed and prepared every step of the way.