Guide To The Resource Utilization Group Rug Payment System

This is your guide to Texas's Medicaid payment system for nursing homes. When newly admitted long-term care residents first arrive into a skilled nursing facility, they'll get an assessment from the staff. Each item or element on the assessment is coded into the minimum data set (MDS). A subset of the MDS directly affects the resource utilization group (RUG) calculation, which sorts the resident into one of 44 different RUG groups. Each group gets different reimbursement payments from Medicaid, so it's important to get that right. Learn the state nursing home regulations and laws for Medicaid. This book covers exactly which MDS items affect RUG payment, the 7 major RUG group categories, and medical necessity. There's an item-by-item guide to filling out the assessment form, both for older adults and children. It also goes over what happens during an Office of the Inspector General (OIG) utilization review and how to fill in an MDS correction form. Note: Texas uses RUG-III 34 group model, which is based on the Minimum Data Set (MDS) 3.0. They also calculate the RUG score with the index-maximizing method instead of the hierarchical method from the federal CMS.

The 2015 Master Medicare Guide is packed with timely and useful information to help you stay on top of one of the most complex programs administered by the federal government. The 2015 Edition includes: Over 500 explanation summaries for all aspects of the Medicare program coverage, eligibility, reimbursement, fraud and abuse, and administration Highlights of the Protecting Access to Medicare Act of 2014 (P.L. 113-93) and the Improving Medicare Post-Acute Care Transformation Act of 2014 (P.L. 113-185)""; the most recent physician fee schedule reimbursement fix; A focus on the continuing implementation of the Affordable Care Act as it relates to Medicare, including accountable care organizations and a tighter link between the quality of health care and Medicare reimbursement All discussions include cross-references to relevant laws, regulations, CMS manual sections, administrative and judicial decisions, and more!

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The 2015 Master Medicare Guide is a one-volume desk reference packed with timely and useful information for providers, attorneys, accountants, and consultants who need to stay on top of one of the most complex programs maintained by the federal government.