HCS, LLC RUG-III Analysis Software

Healthcare Consulting Services, LLC (HCS), can provide hospital-based SNFs and free-standing Medicare-certified nursing facilities with software that will assist facilities in improving the accuracy of RUG-III classification and appropriateness of corresponding reimbursement. Inaccuracies in classification can result in lost reimbursement of $50 to $100 per day per resident.

At HCS, we have found that most SNFs understate their residents RUG-III score and, therefore, are underreimbursed for the services they are providing. Underscoring often results from:

	Failure to adequately assess the clinical and functional status
	Failure to document adequately in the medical record
	Failure to follow guidelines for scoring residents on the MDS (Minimum Data Set)

Written for Windows 95, the Pathlinks Case Mix Coach ® software imports a standard HCFA-defined MDS transmission file, classifies each MDS using Medicare RUG-III grouper and then provides the user with online, interactive coaching messages and printed coaching worksheets. Coaching messages provide guidance for reviewing the accuracy and completeness of the clinical documentation and MDS entries relative to RUG-III classification. Using Pathlinks Case Mix Coach®, the MDS coordinator can focus on problems with individual resident’s MDS, target training for staff members on specific sections of the MDS or certain types of residents, redesign forms to facilitate appropriate documentation and monitor MDS documentation as part of the facility’s quality improvement program.

Pathlinks Case Mix Coach® was designed to work in conjunction with a facility’s MDS software but to work independently from it so that no MDS changes might accidentally be entered into a resident’s official MDS. MDS transmission files are accumulated for case mix-related analysis and reporting over extended periods of time (e.g., 30 or 90 days). Pathlinks Case Mix Coach® produces a variety of useful reports including a coaching message worksheet.

Additional features:

The federal and state versions of the RUG-III groupers for states using the MDS 2.0 for Medicaid reimbursement

Staffing benchmarks based on both the applicable 1990 or 1995/97 (for Medicare) HCFA time studies

"Prospective Resident" function for evaluation of possible classifications of prospective residents or new admits

Training tool for staff to learn how MDS data impact RUG-III classification

For more information about Pathlinks Case Mix Coach®, call Pauline Clark at (317) 633-4708, Ext. 403 or e-mail at pclark@hcs-healthcare.com.

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