If the billing period for an assessment is split between fiscal years, both FY 2011 and FY 2012 RUG-IV groups will both be needed in order to bill for the entire period.
To assist in this transition, the CMS Assessment and Submission and Processing (ASAP) system was upgraded on 9/18 to calculate both FY 2011 and FY 2012 RUG-IV groups for assessments with ARDs from 8/22/2011 through 10/31/2011 so that Final Validation reports will reflect both RUG groups.
If an ARD (A2300) is before 10/01/2011:
- Z0100A (Medicare Part A HIPPS code) should reflect the FY 2011 RUG IV group.
- Warning -1059 on the Final Validation Report will indicate the proper FY 2012 RUG IV group to use for billable days after 10/01/2011. This warning's purpose is to help facilities during the transition by providing the FY 2012 RUG IV group in case the assessment has billable days in both fiscal years.
- If the value for Z0100A is filled in with the FY 2012 RUG IV group (instead of the correct FY 2011 RUG IV group), the CMS ASAP system will generate a -3616a "Incorrect HIPPS/RUG Value" warning indicating the correct RUG value for Z0100A using the FY2011 RUG IV logic.
If an ARD (A2300) is on or after 10/01/2011 but before 10/31/2011:
- Z0100A (Medicare Part A HIPPS code) should reflect the FY 2012 RUG IV group.
- Warning -1060 on the Final Validation Report will indicate the proper FY 2011 RUG IV group to use for billable days prior to 10/01/2011. This warning's purpose is to help facilities during the transition by providing the FY 2011 RUG IV group in case the assessment has billable days in both fiscal years.
- If the value for Z0100A is filled in with the FY 2011 RUG IV group (instead of the correct FY 2012 RUG IV group), the CMS ASAP system will generate a -3616a warning "Incorrect HIPPS/RUG Value" indicating the correct RUG value for Z0100A using the FY 2012 RUG IV logic.
If an ARD (A2300) is on or after 11/01/2011:
- Z0100A (Medicare Part A HIPPS code) should reflect the FY 2012 RUG IV group.
- No transitional RUG warning will be generated on the Final Validation report.
If you continue to receive warning -3616a "Incorrect HIPPS/RUG Value" or a -3616b "Incorrect RUG Logic Version" for assessments with an ARD after 10/01/2011, contact your clinical software vendor to insure that your clinical software has been updated to use version 1.0166 of the RUG-IV logic along with the new set of Case Mix Indexes (CMIs) for FY 2012.
Additional information regarding the FY 2012 RUG IV transition can be found on the CMS website under FY 2012 RUG IV Education and Training. If you need additional information, please contact your state MDS staff or the QTSO helpdesk.
If you have any additional questions, please do not hesitate to contact the SimpleLTC Support Team.
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