Category: RUG-IV

CMS releases FY 2019 proposed rule, includes RCS-1 replacement

CMS has posted a proposed rule for FY 2019. The proposal not only changes payment rates, but also proposes a new case mix grouping called the Patient-Driven Payment Model, or PDPM. This model replaces the RCS-1 that was proposed in May of last year. According to CMS, this new system has 80% fewer groupings and […]

Ask the expert: Therapy billing

Q: We did an M5/d/c/SOT on a resident that was admitted on 3/6 and discharged on 3/7. All therapies were treated on the last day. Here is some more information: ADL RUG IV score: 3 PT: 60 min OT: 60 min ST: 25 min Total: 145 min We submitted and then received fatal error ID […]

Ask the expert: ARD dates

Q: I have a scenario that I find a bit confusing: Admission: 12/13/12 M5: 12/20/12 M14: 12/27/12 M30: 1/9/13 MD ordered home rehab: 1/11/13 EOT DONE 1/13/13 EOT-R: 1/14 then on 1/20/13 When would the COT be? Can these dates be correct? A: The ARD dates in the scenario are within the allowable timeframes, providing […]

Ask the expert: Hospice coding

Q: If someone is on Hospice and a hospice worker gives that person a bath, which they do in our building, we were instructed that we cannot take credit for it on the MDS—so would we code it not assessed? Doesn’t make much sense, being that it is not one of the late loss ADLs […]

What is a nursing RUG?

Q: What is a nursing RUG?

A: A “nursing RUG” is industry lingo for RUG-IV scores in Extensive Services, Special Care High, Special Care Low, and Clinically complex categories, because clinical rather than rehab conditions and services trigger a beneficiary into those categories.

Does coding for IV fluids in Section K for the 7-day look back period affect the RUG level and reimbursement rate?

Q: Does coding for IV fluids in Section K for the 7-day look back period affect the RUG level and reimbursement rate?
 

A: Yes, it does impact the RUG-IV level and reimbursement category. By checking IV fluids in MDS item K0510A, the beneficiary will classify into the Special Care High category (Hxx). Don’t forget to review the instructions in the MDS User’s Manual before checking this item to be sure the resident meets the requirements.

For tracking COTs, is it a continuous 7-day rolling period or does the 7-day observation start over on the day the resident actually changes to a different RUG?

Q: For tracking COTs, is it a continuous 7-day rolling period or does the 7-day observation start over on the day the resident actually changes to a different RUG? In other words, should a COT ARD be done on day 7 of the observation period if a resident changes RUG categories or on the actual […]