Assign a resident to a resource utilization group (RUG). To assign the resident
ID: 3223553 • Letter: A
Question
Assign a resident to a resource utilization group (RUG). To assign the resident to a RUG, use information from the following sources: Case below & Figure 8.6 in your textbook Case The resident requires isolation because of an infection (extensive service). The resident received 740 minutes of therapy. These minutes were received when the resident had physical therapy on Monday, Tuesday, Wednesday, Thursday, and Friday and had speech therapy on Monday, Wednesday, and Friday. The resident’s ADL score is 9.
Based on these data, into which RUG is the resident grouped? Is the RUG one of the upper groups?
2. For Decatur, AL (CBSA 19460), use data from tables 8.13, 8.16, and in the textbook to calculate and IRF-PPS payment for HIPPS codes B0110 and D0101.
4. Apply concepts from the home health prospective payment system (HHPPS).
a. Determine a health insurance prospective payment system (HIPPS) code for the HHPPS using key data and information in table 8.29 in the textbook.
Key data:
• Third episode, 16 therapy visits
• Moderate scores in clinical, functional, and service dimensions
• Supply severity level 4
What is the HIPPS code based on these data?
b. For HHAs delivering services in 2015 to patients in Abilene, TX and Anchorage, AK, create an Excel spreadsheet to calculate the payment for the HIPPS code you determined in 4.a. Both submit quality data. Use the following data:
• NRS amount, the HIPPS weight, the national 60-day episode rate (with quality data), labor-related portion, and the nonlabor-related portion from tables 8.28, 8.30, and 8.31 in the textbook.
• Wage index for CBSA 10180 (Abilene, TX) = 0.7440
• Wage index for CBSA 11260 (Anchorage, AK) = 1.2419
c. Review your calculations in the spreadsheet. What is a cause of the difference in the payments between the two agencies?
d. Review your results. If the two HHAs did not submit quality data, what would be the general effect on their payments?
patients Patients Rehabilitation require extensive extensive Services Services Patients receive at leas 45 minutes. of therapy per week Patients do not require Rehabilitation patients extensive Services Patients require skilled Patients or extensive do not services reCeIVe at leas 45 minutes. of therapy Patients per week typically do not require skilled nursing care Ultra high extensive (over 720 minutes 2 RUGs Very high extensive (500-719 minutes 2 RUGs High extensive (325-499 minutes) 2 RUGs Medium extensive (150-324 minutes 2 RUGs Low extensive (45-149 minutes. RUG Ultra high (over 720 minutes) 3 RUGs Very high (500 719 minutes) 3 RUGs High (325-499 minutes) 3 RUGs Medium (150-324 minutes) 3 RUGs Low (45-149 minutes. 2 RUGs Extensive services 3 RUGs Special care high 8 RUGs 8 RUGs Special ca Clinically complex ORUGS mpaired cognition 4 RUGs Reduced physical function ORUGSExplanation / Answer
Assign a resident to a resource utilization group (RUG). To assign the resident to a RUG, use information from the following sources: Case below & Figure 8.6 in your textbook Case The resident requires isolation because of an infection (extensive service). The resident received 740 minutes of therapy. These minutes were received when the resident had physical therapy on Monday, Tuesday, Wednesday, Thursday, and Friday and had speech therapy on Monday, Wednesday, and Friday. The resident’s ADL score is 9.
Based on these data, into which RUG is the resident grouped? Is the RUG one of the upper groups?
Below are the summary of the information.
The resident received 740 minutes of therapy.
The resident requires isolation because of an infection (extensive service).
Based on the data, the resident will be grouped in the 2 RUG's, as the patients receive atleast 45 minutes of therapy and patients require extensive services and Ultra high + extensive(over 720 minutes).
2 RUG's is one of the lower RUG group.