Introduction to RCS

The SNF Medicare Part A reimbursement system is expected to transition to a new methodology on October 1, 2018.  The “Resident Classification System” adds significant complexity to payment classifications, and relies on resident condition as opposed to therapy utilization for case-mix grouping.  The current RUG model includes 66 payment levels, and the typical facility bills fewer than 20.  RCS creates four distinct, clinically-dynamic components (plus one static rate based on geography) to compute a “composite rate” with over 139,000 possible combinations (although some are mutually-exclusive).   Other structural changes include elimination of most assessments currently require for Medicare Part A patients and “variable day weight adjustment” for therapy and ancillary payment rates.  This complexity will require a thorough understanding of all MDS sections and continuous, diligent management to ensure accurate reimbursement.

As a result of this presentation, the participant will be able to identify the distinct reimbursement drivers for each of the five RCS rate components, and understand the structural mechanics of the Resident Classification System.