Ask the payment expert: highlighting changes to the new RUGs IV system

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Ask the payment expert
Ask the payment expert
What changes will be seen with the new RUGs IV system?

What the Centers for Medicare & Medicaid Services is proposing are revisions in the present RUGs III system. We anticipate seeing our RUGs levels go from 53 groups to 66 groups. Some of the changes could include limitations in the usage of concurrent therapy, two separate Special Care categories (high and low) and a combination of behavior and cognitive limitations.

Concurrent therapy is therapy being performed with more than one resident at a time. This is not uncommon in therapy gyms, where a therapist may be supervising one resident doing exercises and performing therapy on another. Concurrent therapy may be limited the same way group therapy is now limited, or it may result in the therapist having to split the minutes between the residents. We will have to wait for the final rule to see that decision.

Extensive Services probably will be changed to eliminate IV medications, IV fluids and suctioning. IV medications and fluids could move to Clinically Complex with only services done in the facility counted. Extensive Services also could change to include isolation.

All of these changes are a result of the STRIVE studies that were completed in the last few years to update the time it takes to care for residents. We as an industry requested the new time studies and now we will have to deal with the changes that occur because of them.

Above all, we will need to learn the new system so that we can still optimize our reimbursement. Optimizing reimbursement means getting paid the proper amount for the care you are providing to the resident.

Once the final rule is published and the MDS 3.0 is finalized, training will begin in the new systems. Expect that next year will be a year of change!