A proposed Centers for Medicare and Medicaid Services (CMS) rule could have a negative impact on reimbursement for skilled nursing facilities (SNFs).
The proposed rule, released on May 1, calls to implement a new case-mix classification model, known as Resource Utilization Group, Version Four (RUG-IV), for FY 2011. Some of the changes incorporated into RUG-IV significantly deviate from the currently used model, RUG-III.
Medicare uses a case-mix classification system to assign a nursing home resident to a RUG category based on his or her medical conditions and the resources needed to provide care. Each RUG category is tied to a Medicare payment rate. Based on results from the Staff Time and Resource Intensity Verification (STRIVE) project, CMS believes that the RUG-III system is no longer an effective way to determine resource time required to care for certain conditions.
Some of the changes incorporated into RUG-IV are:
For a chart of the proposed RUG-IV categories and other useful tools, visit the Resources page of MDSCentral.