For the 5.12 Medicare RUG III grouper there are two sets of indexes (which determine the rate) Rural and Urban. If you are in an Urban area (by zip code) your software should use the Urban index table. There may be a software switch in your software that sets which index set is to be used. If your software company can't help, you can get free software from the CMS.gov site - either full RAVEN or just a grouper. Both can import an MDS export file and calculate the RUG group using any of the index sets. The grouper has the option to enter only the 108 MDS items that calculate the RUG group and calculate for you.
As long as the HIPPS on the claim is correct, you don't have to worry about a false claim. If it is not correct there can be serious consequences. The error generated when the State system recalculates is not a fatal error, but is a warning to you to get correct software. Also, read the attestation statement on the MDS - they have to be accurate! You might want to get your administrator talking to your software vendor since they may be putting you (and the administrator) at risk. Dave Oatway -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Baker, Margaret (SNMH) 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?? 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 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 > > > > > >CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, >is for the sole use of the intended recipient(s) and may contain >confidential >and privileged information. Any unauthorized review, use, disclosure or >distribution is prohibited. If you are not the intended recipient, >please >contact the sender by reply e-mail and destroy all copies of the >original >message. > >-----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 >-----------------------------------------------------------/ _________________________________________________________________ Fretting that your Hotmail account may expire because you forgot to sign in enough? Get Hotmail Extra Storage today! http://join.msn.com/?PAGE=features/es /---------------------------------------------------------- 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 -----------------------------------------------------------/ > 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 -----------------------------------------------------------/ /---------------------------------------------------------- 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 -----------------------------------------------------------/
