Patch018 – September 2005 Update

This patch contains the latest updates for: 1) MDS 2.0 Section 'W' , 2) RUGS '53' Grouper Version 5.20 (effective date January 1, 2006),  3) Medicaid HIPAA 835 Cash Remittance updates and 4) Medicare Rates for New York City and Nassau/Suffolk Counties.

MDS 2.0 Section ‘W’ (effective October 1, 2005)

The MDS software has been programmed for Section ‘W’.

Rugs ‘53’ Grouper Version 5.20 (effective January 2, 2006)

Version 5.20 implements the 2005 refinement to the RUGS-III grouper model. This makes use of a ’53-group’ model replacing the ’44-group’ model starting in January 2006. This model places the combined Rehabilitation/Extensive groups at the top of the hierarchy. The ’53-group’ model will be used in the Medicare SMF payment system beginning January 1, 2006.

Rug-44  will be used for billing all SNF days of services through December 31, 2005.

Rug-53 will be used for billing all SNF days of services starting with January 1, 2006.

The earliest PPS assessment ARD that could require a Rug-53 (for billed days of service on or after 01/01/2006) is 11/22/2005. The ARD window for a PPS 60-day assessment starts 11 days before the corresponding 60-day assessment payment period and the 60-day assessment lasts for up to 30 days.

The Charts billing program is configured to recalculate MDS assessments with ARD dates between 11/22/05 and 12/31/05 when billing service dates after January 1, 2006 to automatically use the new Rug-53 model in the billing calculation. Additionally, the billing program will recalculate an MDS assessment with an ARD date after 01/01/2006 that affects 2005 billing. This can occur when a resident is admitted in late December 2005 and the MDS 5-day assessment is done in early January 2006.

We have modified the Rugs III Grouper printout to allow a client to see what the score for past assessments would have been had the Rug-53 Grouper been already in place. To run this program,  type M2R3 from any Charts menu and type ‘Y” in response to the question ‘Pretest M2 Rugs 5.20 Grouper’. Those assessments with and ‘*’ after the score indicate that the MDS would score differently under the Rugs-53 grouper.

                             MDS 2.0 Rugs III Grouper

              Resident: A▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ - ZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
              Date    : 01/01/2005           - 12/31/2099
              Bed     : ▬▬▬▬▬▬▬▬▬▬           - ZZ-99999▬▬

              Types- 1-Admission             : Y
                     2-Annual                : Y
                     3-Significant Change    : Y
                     4-Significant Correction: Y
                     5-Quarterly             : Y
                     9-Reentry               : Y
                 6/7/8-Discharge             : Y
                     0-Other                 : Y

              Name/Bed/Unit/SS# order        : N
              Latest                         : N
              Print option                   : S
              Print Active Residents Only    : N
              Verify MDS 2.0 record          : N   Pretest Rugs 5.20 Grouper: Y

Note: If you are not using CHARTS MDS to store the entire MDS record then the following option must be set in User-Parameters before doing your December billing:  In [UP, 14] set option #25,  Bypass Rugs 53 to Y.

If you are not using CHARTS MDS you will also need, in January and in February, to manually reset the RUGs score to the "Rugs 53 Grouper" score when it has changed.

RUGS 53 Grouper (The new categories, i.e., the first 9, are in bold.)

HIPAA Cash Receipts – Medicaid [AR, 4, 10]

The HIPAA 835 cash receipts program now displays the cycle # on the printout along with the HIPAA 835 file name. The program has also been refined to better understand Adjusts / Voids and Retro Reimbursements.

Updated Medicare Rates for New York City and Nassau /Suffolk Counties

Note:  The rates should only be updated after the September 2005 Medicare billing has been posted.

The update include the October 2005 and the January 2006 rate revisions for Medicare.

To update your rates type ‘RHSTF’ from any Charts menu.

The ‘R.H.S. Table File’ should be initialized to ‘TFRATE05’. Press Enter.

The updates rated can be viewed in Print Table File ‘PTF’ – AR, 25 Medicare Rates or modified in Change Table File ‘CTF’ – AR, 25 Medicare Rates.

Load RHS table file to client


          R.H.S. Table File: TFRATE05  Library: CHARTS▬▬  Volume: VOLB▬▬

          Client Table File: TFFILE▬▬  Library: ________  Volume: VOLB▬▬

          Delete the Specific Table before copying  : N  (Yes, No, Default)

          When using default, if RHS file="NEWTF"  it won't delete.
                              if RHS file="NEWTF2" it will  delete.