Rug 66 Classification System

Cms updates federal rates annually.

Rug 66 classification system.

If the resident qualifies in the extensive services group and a special care high group always choose the extensive services classification because it is higher in the hierarchy. This system primarily. Assessment process using a new patient classification system called the patient driven payment model pdpm pdpm beginning october 1 2019 you must use the pdpm patient classification model. Logic version 1 03 and code version 1 03 0 july 18 2013.

To reflect snf care inflation in the cost of goods and services. Rug iv categories and characteristics 1 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. In the rug iv 48 group model compared to the rug iv 66 medicare group model the rehabilitation groups have been collapsed from 23 to 5 groups and the different levels of rehabilitation service are only distinguishable by the adl range. Rug iv classification system 66 group with medicare case mix indices for 10 1 2010.

Rug iv classification system 66 group with medicare case mix indices for 10 1 2010 instructions. The urban institute re examined prior efforts by abt associates 2000 and dr. This method is stemming from the snf pps fy2012 final rule and was previously rug iii. Rug assignments weights are applied at the individual level but the average relative risk of a facility s residents is typically used to adjust the nursing components of state medicaid payment systems one exception.

Brant fries 2003 using data from our 2001 analysis files and replicated and validated the research. Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies. Minimum data set supportive documentation guidelines rug iii version 5 12 34 grouper june 1 2012. There is no transition period from rug iv to the pdpm.

The simplified rehabilitation classification in the 48 group model is better suited for long term care. Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels. Use the hierarchical classification worksheet in chapter 6 of the rai manual. Rug iii version 5 2 calculator worksheet 34 group model.

When you find the first of the 66 individual rug iv groups for which the resident qualifies assign that group as the rug iv classification. Payment is determined by categorizing patients into groups based on their care and resource needs.