Rug Modifier 17

Must use the modifier 59 in addition to the u modifier when mds 3 0 version 1 13 changes effective 10 1 15 ohio department.

Rug modifier 17. Brant fries 2003 using data from our 2001 analysis files and replicated and validated the research. The 30 day is shown as the medicare reason for assessment and the hipps modifier code used for. For late assessments under pdpm similar to under rug iv the provider will bill the default hipps code for the number of days out of compliance and then the 5 day assessment hipps code for the remainder of the stay unless an ipa is completed. The aim of the rug refinement is to improve the ability of the existing rug iii classification system to explain non therapy ancillary nta costs.

From the cms faqs updated 4 17 19. This page contains information related to the use and maintenance of the health insurance prospective payment system hipps codeset. Effective october 1 2015 excel. Similarly if an assessment is a combined 30 day and an scsa the scsa is coded as the primary reason for assessment.

Ub04 data elements snf hipps modifiers assessment indicators ai bill types patient status. Rug group and the last two positions of the code contain a 2 digit assessment indicator ai code. The combined assessment can then be used when billing the medicare claim. Y9633 and t2031 alr 1 day y9634 alp 1 day.

Rug iii mds 3 0 mapping specifications v1 00 5 this document presents logic that can be used to produce rug iii classifications using assessment items contained on mds 3 0 and accommodates item set changes for assessments on or after october 1 2013 as well as earlier assessments. Access the listings of resource utilization groups rugs for skilled nursing facilities snfs from the links below. Effective october 1 2017 excel. Skilled nursing facilities snfs that provide services including audiology and speech language pathology services to medicare beneficiaries are paid under a prospective payment system pps through part a of the medicare benefit.

Due to rounding a slight variance may exist between the spreadsheets below and actual medicare payments. If a patient requires speech language pathology services based on his or her clinical characteristics medicare requires snfs to provide them regardless of. Annual updates to the pps rates for snfs are required by section 1888 e of the social security. Effective october 1 2014 excel.

Question 9 3 how is the vpd affected by default billing. Pt and ot tf intermediate level of care modifier tf should be indicated when submitting claims for. Sep 19 2014 current billing code. The centers for medicare and medicaid services cms are named in the asc x12 837 institutional claim implementation guide as the code source for hipps codes.

The urban institute re examined prior efforts by abt associates 2000 and dr. The 3 digit classification code assigned to each rug group and newly defined 2 digit assessment indicators that specify the type of assessment used to support billing.