tci Medicare Compliance & Reimbursement - 2007 Issue 1

SNFs: The Way Your Rehab RUGs Shake Out In Your Facility Can Lead To A Shake Up With Your FI

Identify rehab RUG patterns that shout 'come audit me.'You need to identify RUG profiles that could raise red flags so you can see if they are justified--and if not, pull them down the flag pole.What's the hottest audit spot? A pattern where residents receive a medium intensity of therapy minutes rather than high intensity regardless of their rehab needs. CMS has its antennae up for that to happen under the RUG-53 system. That's because residents who receive rehab high plus extensive services (RHX or RHL) will group into medium rehab plus extensive (RMX or RML). The latter...

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