Category i extensive services while a resident.
Rugs iv classification system.
There are two basic approaches to rug iv classification.
Rug iv cheat sheet rug iv classification system 66 group with medicare case mix indices for 10 1 2010 rug iv grouper overview.
1 hierarchical classification and 2 index maximizing classification.
Program rug iv case mix classification system reflected the data collected in changes to the guidelines for medicare level of care determinations gg assessment items and urged cms to map missing values to a.
Determine all of the rug iv groups for which a resident qualifies not just the first group for which the resident qualifies.
In may 2017 cms released an advanced notice of proposed rulemaking anprm which outlined a new case mix model the resident classification system version i rcs i that would be used to replace the existing rug iv case mix model used to classify residents in a covered part a stay into payment groups under the snf pps.
This method is stemming from the snf pps fy2012 final rule and was previously rug iii.
2018 rai user s manual and mds coding updates objectives.
Rapid rug iv guide 48 group classification the rapid rug iv guide is intended to be an at a glance reference providing the mds 3 0 items and criteria for each rug category.
The current worksheet was developed for the hierarchical methodology.
Oct 2 2018 decision by reading the chart.
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.
Resident qualifies as depressed yes no rug iv adl score depressed rug iv class 15 16 yes he2 15 16 no he1.
Having a minimum activity of daily living adl dependency score of 2 or more.
Instructions for adapting this worksheet to the index maximizing approach are included below see index maximizing classification.
Payment is determined by categorizing patients into groups based on their care and resource needs.
Use the hierarchical classification worksheet in chapter 6 of the rai manual.
Logic version 1 03 and code version 1 03 0 july 18 2013.
The d0300 total severity score is greater than or equal to 10 but not 99 or the d0600 total severity score is greater than or equal to 10.
The guide also includes the calculation to determine the resident s late loss adl score.
Rug iv is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.
