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The Financial Impact of RUG-IV

By Pam West

We're well into MDS 3.0 and RUG-IV is here to stay. How is your facility adapting? With the MDS 3.0 came changes to nursing homes that go far beyond the new assessment process. The financial impact that these changes could cause is serious.

Key questions to consider

Have you identified the system processes within your facility that need to be improved?

There were some glitches in the beginning that CMS had to deal with regarding transmissions and underpayments, but those are being corrected.1 Does your facility have any processes that need to be examined as well?

Has your admission team made the adjustment to start accepting more clinically complex residents, or are you still accepting the same type of rehab residents?

Under RUG-IV, the nursing component is weighted at 70 percent in all calculations and therapy is weighted at 30 percent.1

If you did start taking more complex residents, how is your nursing team handling the resident acuity?

It's possible that your facility has taken a financial loss by accepting these types of residents if your staff is not identifying all the qualifiers and end-splits.

Even though RUG-IV lessened the weight of therapy programs, is your facility still contracting at RUG-III rates?

Administration needs to review the contracts now if they haven't done this already.

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