How many rug iv categories

RUG-IV is a patient classification system for skilled nursing patients used by the federal government to determine reimbursement levels.

Payment is determined by categorizing patients into groups based on their care and resource needs. This system primarily determines payment by the number of therapy minutes.

It improves payment accuracy and appropriateness by focusing on the patient rather than the volume of services provided. PDPM focuses on the unique, individualized, and characteristic needs, and goals of each patient, and significantly reduces administrative burden on providers to improve targeting of resources to beneficiaries with diverse care needs.

Classifications from RUG-IV assigns patients to payment classification groups, called RUGs, within the payment components, based on various patient characteristics and the type and intensity of therapy services provided to the residents.

Classifications under PDPM have six payment components that are utilized to derive reimbursement. Utilizing clinically relevant factors, rather than volume-based service for determining Medicare reimbursement. Patient characteristics are used to assign residents to CMGs across the payment components to derive payment.

Nursing classification — The total number of nursing case-mix groups CMGs has been reduced by decreasing distinctions based on functions where the resource utilization costs did not differ. Note that CMS reinforces that the daily skilled requirement would only be satisfied if there were a valid medical reason why both cannot be furnished on the same day. The frequency a service is performed does not, by itself, make it a skilled service.

Medical complexities may also include scheduled medical treatments like dialysis, radiation or chemotherapy that impact toleration of therapy. There is the potential for a greater occurrence of COT assessments.

Medical complexities may also include patients with behavior and cognitive impairments. It is common for these patients to require skilled therapy interventions and have challenges receiving medically necessary therapy.

These patients may also be more likely to refuse a therapy session and require a COT assessment. View Kris Mastrangelo's profile.

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