This might help you:
As discussed already, the Rug score is based on the resident's Highest CMI(Case Mix Index). There is a case where if the resident falls into an RHB and SE3 in one facility he might be the RHB in the one site and at the other he would be an SE3. This is where the CMI for the Rural vs the Urban facilities plays a part. For Rural facilities, the CMI for RHB is 36.000 and the SE3 CMI is 35.000. Therefore this resident would bean RHB. In an Urban facility the CMI for RHB is 35.000 and the SE3 CMI is 36.00, therfore in this facility he would be an SE3. Your example below with the RMB/SE3 is not an example of this since the Rural RMB =34.000 and the Urban RMB =34.00, and the SE3 CMI is (R)35.000 (U)36.000. Is there a spot in your MDS set-up where you have to put Hierarchical vs. Index Maximizing? I would check that as it appears your software is set-up for Hierarchical and Index Maximizing classification is used for Medicare PPS.
-----Original Message-----
From: Baker, Margaret (SNMH) [mailto:[EMAIL PROTECTED]]
Sent: Friday, October 24, 2003 11:12 AM
To: '[EMAIL PROTECTED]'
Subject: RE: rugg rates
When I send in California and I have a person who simultaneously qualifies
for RMB and SE3, my software chooses RMB and the state recalculates to SE3
as SE3 pays more. I am going to have to do a work around this with my
software as it is a pain for billing to have to redo the bill. (Software
company always says it is our fault, not theirs, so it is worthless working
with them.)
-----Original Message-----
From: Stacee Kunse [mailto:[EMAIL PROTECTED]]
Sent: Friday, October 24, 2003 6:11 AM
To: [EMAIL PROTECTED]
Subject: RE: rugg rates
That is what I have thought, but in the rural setting, it gives more
weight to the rehab, and we get the rehab value even though it pays less
than the SE3. I have contacted our state RAI coordinator regarding
this--I couldn't figure out why I was getting rehab rugs when the
resident qualified as SE3--she stated that it was due to the rural
setting. Any other input on this??
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Stacee Kunse, RN
MDS Coordinator
Tuscola County Medical Care Facility
1285 Cleaver Road
Caro, MI 48723
Phone: (989)673-4117
Fax: (989)673-6665
Email: [EMAIL PROTECTED]
>>> [EMAIL PROTECTED] 10/23/03 4:10 PM >>>
It isn't just the projected minutes that puts you in the rehab category,
you can still Rug into SE3 with projected minutes coded on your
MDS--your software should default to the highest paying RUG category not
just the RUG category that is above the others. There are many items
that have to be coded on the MDS for a resident to fall into the
extensive services (specifically SE3 which requires the most), I suspect
that if you are trying for SE RUG category vs a rehab category you are
missing a piece of the criteria needed for scoring and the rehab RUG
rate is indeed the highest rate your resident qualifies for. Remember
you should only shoot for a SE RUG category if your resident will not
make it into a category equal to or higher than a rehab high. It is
certainly valid to try for a SE3 category even if the resident is
receiving therapies because if they are just out of the hospital and had
alot of things going on then the nursing component may require more
skilled services than
the rehab component at least for the first 14 days and we should be
reimbursed at the higher rate to compensate for both the nursing and
rehab skilled services. I hope this makes sense, I do get long-winded.
---Mary
Laurie Prince <[EMAIL PROTECTED]> wrote:
So how do you complete sect T? You have to answer yes to "were therapies
ordered", but therapy hasn't gone in on day 1 to determine days and
minutes.
-----Original Message-----
From: Carol O'Brien [mailto:[EMAIL PROTECTED]]
Sent: Thu 10/23/2003 12:41 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: rugg rates
I would agree with you. We have done this several times. Make sure that
rehab doesn't go in until day 2 or you will have projected minutes which
knocks you right out of the category (learned this the hard way!!!)
>From: "Stacee Kunse"
>Reply-To: [EMAIL PROTECTED]
>To:
>Subject: RE: rugg rates
>Date: Thu, 23 Oct 2003 14:08:57 -0400
>
>If the assessment reference date is set for day 1 though, and there is
>no order for therapy yet, we do not anticipate minutes and days,
>correct? Could you then get the SE3 reimbursement rate?
>
>
>
>
>This e-mail and any attachments are confidential information intended
>for the sole use of the addressee listed. If you are not the intended
>recipient, please notify the sender immediately via return e-mail, or
>call our Management Information Systems Coordinator at (989)673-4117,
>and delete the e-mail. Unauthorized use, dissemination, distribution or
>copying of this e-mail or attachments, in whole or in part, is strictly
>prohibited and may be unlawful.
>
>Stacee Kunse, RN
>MDS Coordinator
>Tuscola County Medical Care Facility
>1285 Cleaver Road
>Caro, MI 48723
>Phone: (989)673-4117
>Fax: (989)673-6665
>Email: [EMAIL PROTECTED]
> >>> [EMAIL PROTECTED] 10/23/03 1:56 PM >>>
>If you have therapy ordered for her, then I would not try to capture
the
>se3. If therapy is going to see her on day 2, then you will still have
>to do the projection for the 1st 15 days. The 5 day assessment pays
>through day 14 and this is what the therapy reimbursement comes out of
>it. The SE3 rate does not have a therapy component. I could capture a
>SE3 for many residents, but, since they have therapy ordered and are a
>candidate, this is not an option.
>
>
>
>I would likely say that therapy will see this resident at a skilled
>level.
>
>
>
>Brenda W. Chance, RN, RAC-C
>
>MDS Coordinator
>
>
>
>
>
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>
>-----Original Message-----
>From: Laurie Prince [mailto:[EMAIL PROTECTED]
]
>Sent: Thursday, October 23, 2003 12:37 PM
>To: [EMAIL PROTECTED]
>Subject: rugg rates
>
>
>
>How can I get a higher nursing rug rate over therapy for a 5 day
>assessment. I want to pick day one for the ARD and capture an SE3.
>Section T requests minutes and days for therapy. Therapy will not be
>starting their eval until day 2. The initial order from the MD is for
>therpy with no freq. If I complete sect T, it defaults to the lesser
>reimbursed rug rate for therapy. Can I put "1" for yes to therapy
>ordered and then -- for minutes and days? Help!
>
>
>/----------------------------------------------------------
>The Case Mix Discussion Group is a free service of the
> American Association of Nurse Assessment Coordinators
> "Committed to the Assessment Professional"
>Be sure to visit the AANAC website. Accurate answers to your
> questions posted to NAC News and FAQs.
> For more info visit us at http://www.aanac.org
>-----------------------------------------------------------/
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/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
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> ATTACHMENT part 2 application/ms-tnef
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
/----------------------------------------------------------
The Case Mix Discussion Group is a free service of the
American Association of Nurse Assessment Coordinators
"Committed to the Assessment Professional"
Be sure to visit the AANAC website. Accurate answers to your
questions posted to NAC News and FAQs.
For more info visit us at http://www.aanac.org
-----------------------------------------------------------/
