HOW WILL THE TRANSITION FROM RUG IV TO PDPM WORK?

Updated: Sep 13, 2019

Written by,

The Patient Driven Payment Model is the biggest reimbursement and regulatory change of Medicare and skilled nursing facilities since the implementation of the PPS and RUGs system in 1998. It is our goal to provide guidance to SNFs to navigate the transition from RUG-IV to PDPM successfully for the benefit of our patients.


For Medicare Part A RUG-IV billing ends on 9/30/19 and PDPM billing begins 10/1/19. The 2 payment systems will not run concurrently.


HERE ARE SOME FACTS FOR THE TRANSITION PERIOD:

- Impacts all Med A patients who are in the facility on September 30 through October 1, 2019.


- FOR RUG-IV: required RUG-IV PPS assessment on or before September 30, 2019 that covers payment through September 30, 2019.

  • Note: Patients who admit on September 27 to September 30, 2019 will not have an opportunity to capture 5 distinct calendar days of therapy and will therefore obtain a Non-Rehab RUG score for the 5-day assessment.

- FOR PDPM: mandatory Transitional IPA required October 1 through October 7, 2019.

  • The ARD to be set no later than October 7, 2019.