Medicare RUG level

For therapists who are working (and will be working ) in skilled nursing facilities, you encounter terms such as  Medicare RUG (Resource Utilization Group) level, reference periods, minutes, etc. has an article titled Capturing Minutes for Occupational Therapy Treatment featuring tips on maximizing time with patients while helping them reach quantitative results.

Capturing Minutes for Occupational Therapy Treatment

If you are an Occupational Therapy practitioner or even a Level II student at a skilled nursing facility, you have probably found it difficult to strike a balance between giving quality treatments in accordance with meeting a Medicare RUG (Resource Utilization Group) level.  Typically, when a patient is admitted to a skilled nursing facility from a hospital, and has Medicare coverage, the MDS coordinator sets reference periods.  If you are new to this area of practice, the reference periods are critical when establishing how many treatment minutes a client can/will receive for Physical, Occupational, and Speech therapy. 

To give you a crash course with reference periods, there are different levels a patient can reach, dependent upon their therapy treatment minutes, nursing intervention (i.e., IV antibiotics), and the period of time the patient will be receiving these.  Furthermore, the assessment period becomes Medicare’s crystal ball.  They have preset reimbursement rates, given the set criteria.  For example, if the patient is receiving 150 minutes of therapy a day during a reference period, Medicare will reimburse accordingly.  If a patient is receiving 30 minutes of therapy combined (OT/PT/SLP) and IV antibiotics, Medicare will reimburse according to the designated RUG level as well.  Generally speaking, the more therapy treatment time the greater the reimbursement.

What becomes even more tricky is coordinating a patient’s medical status (e.g., patient is nauseated and cannot participate with therapy on the day of admit), the amount of time Occupational/Physical/Speech Therapy has to evaluate and treat the patient upon admission (evaluation minutes do not count), nursing assessment (e.g., wound care or IV antibiotics), and how all of this can be combined to determine a patient’s RUG level.  Usually, the MDS Coordinator and Rehabilitation Coordinator work together when setting assessment dates and the treating therapists assist in carrying out the plan. 

Now that you have a small background on what happens when a patient is admitted to a skilled nursing facility, it is time to tap into a frustrating area for Occupational Therapy practitioners.  Many times OT clinicians feel the pressure to see patients for 75 minutes of therapy a day, from their rehabilitation managers.  Rightfully, the patient’s Medicare coverage is paying your facility based on the reference period RUG level for the patient’s stay.  This is the key reason you cannot see a patient for 75 minutes a day during a reference period and then immediately taper them down to 30 minute treatment sessions a day.  This is a fraudulent act.  The reason being, the crystal ball that I previously mentioned, Medicare wants assessment periods set to pay for future dates of therapy.  If a patient was seen for 30 minutes a day by Occupational and Physical Therapy combined during a reference period, Medicare will pay that designated RUG amount for X amount of future days.

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