Accurate CMS Documentation of ADL Self-performance and Support

Since 1997, Medicare has implemented a Prospective Payment System [PPS] for a covered Skilled Nursing Facility service using a prospective, case-mix adjusted per diem payment rate. This methodology has evolved to capture compensation for staff, utility costs, and product costs (pharmaceuticals, food, etc.) and has simplified resident care needs into relatively homogenous reimbursement groups. The present iteration, called the Resource Utilization Groups – Version IV [RUG-IV], has 8 distinct groups outlined, which are tiered by level of skilled service provided, need for extensive services, clinical complexity, and resident cognitive function.