Medicare RUG-53 implementation and rehabilitation service reimbursement changes

¶ … Medicare RUG-53 that went into effect on January 1, 2006. This change added several new groups to rehabilitation coverage that increased the number to 23 groups that will pay for those services. It covers the changes in RUG-53, including no more Medicare add-ons and "wage indices" for many providers. There are several changes that affect Medicare recipients as well. The purpose of the changes is to overall pay more for medical services that are often bundled with rehabilitation services. Most of the changes modify the RUG-44 plan.

The article goes into detail about how rehabilitation services are measured and what qualifies for the RUG-53 benefits. It also tells health care providers how to correctly assess MDS data to make sure their reimbursements are correct and they do not lose revenue. Making sure this financial data is correct also cuts down on financial audits.

It also notes how to deal with clinical inconsistencies in coding medical data that might result in loss of revenue or denial of claims. For example, it discusses the problem of patients who do not get adequate nutrition, but do not have IV's or feeding tubes, and how to deal with situations such as these.