Medicare Demonstration Project - Update for Grouper Version 3.20.
Reliable Health Systems, Inc.
2610 Nostrand Avenue
Brooklyn, New York 11210
___
Tel (718) 338 - 2400
Fax (718) 338 - 2741
January 9, 1997
Dear Client,
The enclosed diskettes contain the latest RHS updates required by all facilities participating in the RUGs III
demonstration project. We have updated the billing program to correctly bill based on the recently outlined
Department of Health guidelines. The billing program also takes into account MDS+ assessments completed
prior to 01/01/97 and will regroup the MDS+ assessment based on Grouper Version 3.20 if a 1996 MDS+
assessment impacts on 1997 billing. The facility does not have to regroup the 1996 MDS+ assessments.
Please note that Step 1 of this letter (loading the enclosed diskettes) is applicable to all clients. Steps 2 through 3
are applicable only to those clients who are participating in the Medicare Demonstration project.
Please note: If your facility is part of the Medicare demonstration project, we assume, that you or someone in
your facility attended one of the DOH Medicare seminars. If you did not attend the DOH Medicare seminar
please ask someone in your facility to explain to you the Medicare Demonstration concepts and guidelines
before attempting to follow the instructions in this letter.
OVERVIEW - Details on the following page:
The following general steps are required before posting Medicare charges for 1997:
Set-up: To be performed only once:
1. Load the enclosed diskettes.
2. Verify that the Billing Sub Type Table has been updated.
3. Enter the Medicare daily rates for 1997 for each of the 45 RUGs III categories.
Processing: Required each month prior to Medicare billing:
4. Post the Medicare Room & Board charges and create the UB92 billing diskette.
doc:f:\wpdoc\rugsiiid
INSTRUCTIONS:
The following steps must be followed before posting Medicare charges for 1997:
Step 1. Load Charts Update Follow the instructions on the diskettes to load them into your CHARTS
system.
For UNIX clients only:
After loading the diskettes logon to CHARTS, type RHSTF from any menu and
Return. This is required to load the new table.
Step 2. Confirm that the Sub Types Table has been automatically updated
From any CHARTS menu type 'CTF' (change a table file), select '8' (Accounts Receivable),
select '19' (Sub Types Options), Enter '9040' and Press RETURN. The item that appears should
have a short description of 'RVB' and the field 'Prior Description' should contain 'RHC-96'.
If this appears exit from the program. If it does not appear as described, please call client
services.
Step 3. Update the Rates and Dates Table for 1997
Medicare billing will be based on the 45 RUGs III classifications. The Rates and Dates table file
must be updated to reflect these 45 rates. This table is accessed by typing TF, 1, 8, 12. Codes 51
- 95 must be used corresponding with the 45 Rugs III codes. Enter all 45 Medicare rates for your
facility (with rate 95 being the Default rate). A complete listing of the Rugs III Classifications
and their corresponding RHS Rates and Dates codes is enclosed. (See the last page, Rugs III
Group - RHS Rate Codes Crosswalk.) Please note that Medicare billing rates still vary from
facility to facility. It is therefore necessary that each facility enter their own billing rates for each
RUGs III group.
For example, for Rehabilitation Ultra High ADL 14-18 (RUC) with a facility specific rate for
that grouping of $180.00 per day, enter the following:
| From any menu type TF,1,8,12 (ENTER) |
|---|
Add
(071-RTD)
RATES AND DATES TABLE
---------------------
Code: 51 Year: 97 Monthly/Daily: D Description: RUC
Percent to use for BedHold:
Rate Date
180.00 - 1/1/97
-
-
Enter (F) To File (I) To Ignore: F
|
Step 4. Post Room and Board Charges and UB92 Billing
Remember that your Medicare MDS+ assessments must be submitted before you do your
Medicare billing. At this point you are ready to post Medicare room and board charges and
create your UB92 billing diskette.
For assistance or for additional information please call our client services department at 718-338-2400. Thank
you.
Sincerely,
Bud Westreich
Vice President, Systems Development
Rugs III Group - RHS Rate Codes Crosswalk
Rugs III M3PI RHS Rates & Dates
Group Revenue Code Table Code
RUC 9044 51
RUB 9043 52
RUA 9042 53
RVC 9041 54
RVB 9040 55
RVA 9039 56
RHC 9038 57
RHB 9037 58
RHA 9036 59
RMC 9035 60
RMB 9034 61
RMA 9033 62
RLB 9032 63
RLA 9031 64
SE3 9030 65
SE2 9029 66
SE1 9028 67
SSC 9027 68
SSB 9026 69
SSA 9025 70
CC2 9024 71
CC1 9023 72
CB2 9022 73
CB1 9021 74
CA2 9020 75
CA1 9019 76
IB2 9018 77
IB1 9017 78
IA2 9016 79
IA1 9015 80
BB2 9014 81
BB1 9013 82
BA2 9012 83
BA1 9011 84
PE2 9010 85
PE1 9009 86
PD2 9008 87
PD1 9007 88
PC2 9006 89
PC1 9005 90
PB2 9004 91
PB1 9003 92
PA2 9002 93
PA1 9001 94
Default 9000 95