What Is Rug Reimbursement

1 2019 the centers for medicare medicaid services cms changed the reimbursement methodology for the medicare skilled nursing facility prospective payment system snf pps from resource utilization groupings rugs to the new patient driven payment model pdpm.

What is rug reimbursement. Brant fries 2003 using data from our 2001 analysis files and replicated and validated the research. Mds 3 0 rug iv 66 category table urban adls end splits rug cmi rate 042 aids 15 16 signs of depression le2 45 412 73 941 02 15 16 no signs le1 33 345 26 787 19 11 14 signs of depression ld2 42 396 66 904 38 11 14 no signs ld1 27 332 42 757 92. The per deim rate is the amount of money provided to the facility to pay for the care of a patient covered under medicare part a. Effective october 1 2015 excel.

Due to rounding a slight variance may exist between the spreadsheets below and actual medicare payments. 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. Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels. Access the listings of resource utilization groups rugs for skilled nursing facilities snfs from the links below.

Payment is determined by categorizing patients into groups based on their care and resource needs. Patient classification system of resource utilization groups rugs. Rugs are mutually exclusive categories that reflect levels of resource need in long term care settings primarily to facilitate medicare and medicaid payment they are assigned to individuals based on data elements derived from the ltc minimum data set mds there is a standard order or hierarchy and each rug is associated with relative weighting factors rug assignments can be made on a hierarchical or an index maximization basis. This method is stemming from the snf pps fy2012 final rule and was previously rug iii.

Effective october 1 2016 excel. 8 comptroller the. Beginning with fy 2019 value based incentive payments will be made to snfs based on their. Effective october 1 2017 excel.

Nursing facility provider reimbursement rule tn gov. The rug level then determines the per diem rate that the facility receives. Longer support rug iii and rug iv case mix methodologies. Effective october 1 2014 excel.

Fee schedule pfs including the professional component of diagnostic. The aim of the rug refinement is to improve the ability of the existing rug iii classification system to explain non therapy ancillary nta costs. The urban institute re examined prior efforts by abt associates 2000 and dr.