Medicare Rate Calculator Available for RUGs-IV and RUGs-III Hybrid System

VHCA (09/3/10)

In July the Centers for Medicare and Medicaid Services (CMS) released the Final Notice for the skilled nursing facility Medicare prospective payment system with the final rates under the RUGs-IV system (interim payment system, effective October 1, 2010, until CMS develops the hybrid grouper) and the hybrid system (payment system as mandated by the health care reform law passed on March 23).

To comply with the Patient Protection and Affordable Care Act (ACA) of 2010, CMS will determine payment using the Minimum Data Set (MDS) 3.0 with a “hybrid” RUG III system, or HR-III, that only incorporates two components of RUGs IV (“look-back” period and concurrent therapy provisions). Because CMS has not yet developed a grouper for the hybrid RUG III payment system, effective Oct. 1, CMS will implement an interim payment system using the MDS 3.0 and RUGs IV. Once the hybrid RUG III system is in place, CMS will retroactively adjust claims paid.  CMS expects the HR-III to be in place no sooner than January of 2011.

Our friends at Health Dimensions Group have again provided an Excel spreadsheet-based rate calculator.  This year’s calculator provides both RUGs-IV and HR-III rates as of October 1st based upon a facility’s geographic location.  Click here to download the rate calculator.