tci Medicare Compliance & Reimbursement - 2006 Issue 15

NURSING HOMES: RUG Software Could Be Costing LTC Facilities Thousands

Software snags may drag down nursing homes' per diems.Without naming names, the Centers for Medicare & Medicaid Services confirmed at a March 16 Open Door Forum that not all software vendors serving nursing homes are accurately assigning Resource Utilization Groups for Medicare payment.Some software is missing out on an absolute essential to appropriate reimbursement under the RUG-53 system: If a resident qualifies for more than one RUG, the application should assign the resident the higher paying group for payment purposes.Some software has been failing to assign the highest paying groups within the top nine new RUGs...

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