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06-07-07
RUG Distribution Analyzer
As a national consulting firm, Zimmet Healthcare Services Group, LLC prepares Medicare cost reports for nearly 200 providers in over 20 states. Contained within this document is the number of Medicare days per Resource Utilization Group (“RUG”), captured and billed for the year. This “RUG Distribution” translates directly to aggregate, and average, Medicare Part A revenue.
2006 continued the pattern we have seen since the inception of PPS: New York State skilled nursing facilities (“SNFs”) report a significantly lower RUG Distribution than do providers in most other states.
Pursuant to data published by the Centers for Medicare and Medicaid Services, using the average, “unweighted” RUG rates, New York SNFs reported an average Medicare rate of $343.92 per day in 2006, while the national daily rate average was $376.98. For local comparatives, New Jersey providers earned $395.85 (15% higher than New York), while Pennsylvania facilities received $374.31 (9% higher).
Based on our experience, there is nothing clinically or demographically “atypical” about New York residents that would explain this variance.
To see how your facility’s RUG Distribution measures up to SNFs in other states, we have posted a “RUG Distribution Analyzer” on our website. Once completed, this spreadsheet will calculate your facility’s average rate, and highlight significant variances in the most important reimbursement drivers. To use the “RUG Distribution Analyzer” enter the following ID and Password in the Client Login Section Above:
ID: rugda
PW: rugda7
Note that systemic “downcoding” is not only a Medicare issue. As New York transitions to an MDS-based Medicaid system, well prepared facilities may realize significant Medicaid reimbursement benefits as well.
In our upcoming seminars, we will be discussing the “New York Condition” of relatively low average Medicare reimbursement. Our consultants will share the techniques that providers in other states have mastered, so that you may return to your facility and implement these important strategies and increase Medicare revenue. We hope to see you at one of the following programs (click on "Seminars" above for details on our "Focus on Reimbursement" series):
July 18, 2007: Syracuse, NY
July 19, 2007: Albany, NY
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