Ask the payment expert: the efect of a RUGs-IV delay, info on the Quality Indicator Survey process

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Ask the payment expert
Ask the payment expert

How is the delay on the implementation of RUGs-IV going to affect us?

As of press time, we don't know what is going to happen in October. It will take congressional action to undo the delay in the implementation of RUGs-IV.

The Centers for Medicare & Medicaid Services says that if the delay remains, it still plans on implementing some of the pieces of the RUGs-IV methodology. This includes the elimination of the “look-back” period into the hospital stay and the implementation of concurrent therapy.

This implementation with the existing RUGs-III system could have a significant financial impact on facilities.  During the CMS Train the Trainer sessions in Baltimore, CMS representatives stated that they are preparing training in the RUGs payment system this summer.

The key right now is for your staff to continue learning the MDS 3.0. We will then have to look at the payment system as it gets closer to October. Remember, strategies such as strategic management of the ARD will still be important to you. In addition, your facility needs to evaluate how your RUG levels may change.

Making sure good processes are in place now can have a positive impact on managing the new payment system—whichever one it might be!

Where can we find information on the new Quality Indicator Survey process?

CMS has some information on the QI Survey process in Appendix PP of the survey manual. You can find that info at the CMS website. You can also check the University of Colorado website for the QI Survey forms. CMS has not provided us with any additional information.