Case Mix Adjustment Rug Iv

The fy 2018 case mix adjustment applies the rug iv system comprising 66 groups and mds 3 0 assessment data to the therapy and nursing snf per diem rate components.

Case mix adjustment rug iv.

Rug iv case mix review fact sheet directory pdf updated 11 2013 fact sheet 1. Cms assigns a case mix index cmi to each rug based on the average cost of a snf resident in that payment group. What is case mix. Pdf fact sheet 3.

Classification under rug iv a large majority of snf residents receive therapy and their case mix group is determined primarily by the number of therapy minutes they receive. The snf pps also includes an administrative presumption whereby a beneficiary who is correctly assigned one of the designated more intensive case mix classifiers on the initial 5 day medicare required assessment is automatically. Physical therapy pt occupational therapy ot speech language pathology slp nursing and non therapy ancillaries nta. The new rug iv categories are the result of the strive study of rug iii reimbursement and the development of the mds 3 0 instrument.

Understanding the different care requirements of patients forms the basis for comparing health care organizations and case mix adjusted resource use. The payment for room and board is a constant amount for all rugs. Figure 2 rug iv classification system rug iv classification scheme figure 1. Who to call for case mix information.

The remaining component is a non case mix component as existed under the previous rug iv. Cihi s case mix methodologies are used by hospitals health regions and ministries of health to help monitor and improve the care and services provided. Pdf fact sheet 1a. Case mix questions answers pdf fact sheet 4.

Many states currently use a rug based payment methodology for medicaid covered nursing facility stays and so this change is prompting states to assess whether they should change their methods of determining patient acuity for medicaid payment. Cms calculates separate cmis for nursing and therapy services. What assessments are used for case mix. To case mix adjust the rate for pt and ot you ll compute the new function score that cms created based on section gg s items table 18 facilities should expect changes to this section and for the mds to require more from our thera pists as opposed to rug iv which depended on input from cnas to section g.

5 concerns about the provision of therapy services the rug iv model assigns snf residents into rehabilitation or non rehabilitation rugs. Requesting a reconsideration pdf. Component is case mix adjusted for rehabilitation rugs and is a constant amount for nonrehabilitation rugs. Of these are case mix adjusted components.

Medicare s daily base rates unadjusted for case mix or wage differences for fiscal year 2018 are shown in table 1. Financial impact of rug iv. Healthcare financial management association 3.