What are Medicare RUG levels?
There are seven major RUG categories: Rehabilitation, Extensive Services, Special Care, Clinically Complex, Impaired Cognition, Behavior Problems, and Reduced Physical Function. These categories are further divided into 44 subcategories, each of which has a different Medicare payment rate.
What does rug stand for in healthcare?
Resource Utilization Groups
Resource Utilization Groups, or RUGs, flow from the Minimum Data Set (MDS) and drive Medicare reimbursement to nursing homes under the Prospective Payment System (PPS). A resident is initially assigned to one of the seven major categories of RUGs based on their clinical characteristics and functional abilities.
What is reduced physical function category?
The Reduced Physical Function resource utilization group (RUG) includes residents who may or may not have received assistance with activities of daily living (ADLs), such as eating, bed mobility, transferring from one surface or another, and toileting.
What is RUG classification?
RUG-III first tests whether a SNF resident qualifies for each of the seven major categories: (1) rehabilitation, (2) extensive services, (3) special care, (4) clinically complex, (5) impaired cognition, (6) behavior problems, and (7) reduced physical function.
What is a RUGs score?
The RUG score shows the type and quantity of care required for each individual resident. RUG scores consist primarily of the levels of occupational, physical and speech therapy a patient receives along with the intensity of nursing services the patient requires.
How many major categories are in the rug-IV classification system?
Then work down through all of the 66 RUG-IV Classification groups, ignoring instructions to skip groups and noting each group for which the resident qualifies.
What is clinically complex?
The Clinically Complex resource utilization group (RUG) includes residents who received. assistance with activities of daily living (ADLs), such as bed mobility, eating, transferring from. one surface to another, and toileting.
How is ADL score calculated?
The ADL score is a component of the calculation for placement in RCS-I nursing groups. The ADL score is based upon the four “late loss” ADLs (bed mobility, transfer, toilet use, and eating), and this score indicates the level of functional assistance or support required by the resident.
How is PDPM score calculated?
1 Calculate the sum of the Function Scores for Sit to Lying and Lying to Sitting on Side of Bed. Divide this sum by 2. This is the Average Bed Mobility Function Score. Determine the resident’s primary diagnosis clinical category using ICD-10-CM and ICD-10-PCS codes recorded in MDS item I8000.
What is the patient driven payment model?
The Medicare Patient-Driven Payment Model (PDPM) is a major overhaul to the current skilled nursing facility (SNF) prospective payment system (PPS). It is designed to address concerns that a payment system based on the volume of services provided creates inappropriate financial incentives.
Did PDPM replace rugs?
What is PDPM? Patient-Driven Payment Model. The Patient-Driven Payment Model (PDPM) is the proposed new Medicare payment rule for skilled nursing facilities. It is intended to replace the current RUG-IV system with a completely new way of calculating reimbursement.
Does the MDS link to reimbursement?
The MDS (Minimum Data Set) is a direct link to reimbursement, consumer ratings and interdisciplinary teamwork.