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Ask the payment expert: Can a facility bill a higher RUG rate for two residents in isolation?

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Patricia Boyer, MSN, NHA, RN
Patricia Boyer, MSN, NHA, RN
Q: Can a facility bill a higher RUG rate (isolation rate) when two residents are sharing a room for the same isolation reasons? Or does the resident need to be all alone in a room?

A: First, a RUG rate is billed for each resident, so if two residents are in isolation for an infective disease, each resident would qualify for RUG payment.

Secondly, each resident requires a private room. According to the RAI Manual, code only when the resident requires strict isolation or quarantine alone in a separate room because of active infection (i.e., symptomatic and/or have a positive test and are in the contagious stage) with a communicable disease, in an attempt to prevent spread of illness.

Transmission-based precautions must be considered regarding the type and clinical presentation related to the specific communicable disease. The three types are contact, droplet and airborne.

More information related to the types of transmission-based precautions can be found in the “2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings” (www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf).

“Strict” isolation means the resident must have a private room, according to the CDC guidelines referred to above. Appendix A shows infections and types of precautions are needed. Standard precautions require no isolation. Contact and droplet precautions may only require isolation in a private room under direction of your infection control expert.

Airborne precautions frequently require special supplies and a private isolation room. Each resident should be considered individually. So, to answer your question, two residents with the same infection in the same room would not qualify for payment for isolation.
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