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The Nine New RUG Categories Explained

 The Final Rule for the changed Resource Utilization Groups (RUGs) was recently published in the Federal Register by CMS. The RUG refinements will be implemented on January 1, 2006. Nine new payment categories have been added, bringing the number of RUG categories from 44 to 53. 

Residents in the Rehabilitation and Extensive Services groups will qualify for the new RUG groups if they are receiving both Rehabilitation and Extensive Services.

The other RUG categories will not be affected: (Special Care, Clinically Complex, Impaired Cognition, Behavior, Reduced Physical Function).

 New RUG Categories 

 

 

 

Category

 

 

ADL Index

 

 

RUG Code

 

New Rehabilitation

 Plus Extensive Services Groups

 

 

Rehabilitation Ultra High

 

Therapy 720 minutes per week, at least 2 disciplines

 

 

16-18

 

9-15

 

4-8

 

 

RUC

 

RUB

 

RUA

 

 

RUX  (ADL 16-18)

 

RUL  (ADL 7-15)

 

 

 

 

 

 

Rehabilitation Very High

 

Therapy 500 minutes per week, at least 1 discipline

 

 

 

16-18

 

9-15

 

4-8

 

RVC

 

RVB

 

RVA

 

 

RVX  (ADL 16-18)

 

RVL  (ADL 7-15)

 

 

 

 

 

 

Rehabilitation High

 

Therapy 325 minutes per week, 1 discipline

 

13-18

 

8-12

 

4-7

 

 

RHC

 

RHB

 

RHA

 

 

RHX  (ADL 13-18)

 

RHL  (ADL 7-12)

 

 

 

 

 

 

Rehabilitation Medium

 

Therapy 150 minutes per week

 

 

 

15-18

 

8-14

 

4-7

 

RMC

 

RMB

 

RMA

 

 

RMX  (ADL 15-18)

 

RML  (ADL 7-14)

 

 

 

 

 

Rehabilitation Low

 

Therapy 45 minutes / 3 days per week

2 restorative nursing activities 6 days per week

 

 

 

14-18

 

4-13

 

 

 

RLB

 

RLA

 

 

 

RLX  (ADL 7-18)

 

 

 

 

 

Extensive Services

 

IV Feeding in last 7 days

 

In last 14 days:

IV Medications

Suctioning

Tracheostomy Care

Ventilator / Respirator

 

 

 

 

 

More information on maximizing MDS reimbursement can be found in the book:

The MDS Coordinator's Handbook

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