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Therapies play an important role in the formation of the Medicare RUG. There are several levels of therapy that will be very briefly explained here.

Rehab Ultra High. This is the highest level of therapy. The are several requirements to meet this RUG level. One requirement for this level is that 720 minutes of therapy must be provided in the past 7 days. There are other requirements to meet this level. Rehab Ultra High RUG's are RUC, RUB, RUA. Additionally, with extensive services the Rehab Ultra High RUG's are RUX and RUL.

Rehab Very High. This is the second highest level of therapy RUG in the SNF setting. One requirement for this level is 500 minutes of therapy provided 500 minutes of therapy must be provided in the past 7 days. There are other requirements to meet this level. Rehab Very High RUG's are RVC, RVB, RVA. Additionally, with extensive services the Rehab Very High RUG's are RVX and RVL.

Rehab High. This is the next highest level of therapy. There are many rules that can be applied to meet this RUG level. Sometimes only 65 minutes of therapy need to be provided to meet this level. Rehab High RUG's are RHC, RHB, RHA. Additionally, with extensive services the Rehab High RUG's are RHX and RHL. Rehab High generally pays only slightly more than Rehab Medium. Having too many residents at rehab high can be financially devestaing to a facility.

Rehab Medium. This is the second lowest level. There are many rules that can be applied to meet this RUG level also. Rehab Medium RUG's are RMC, RMB, RMA. Additionally, with extensive services the Rehab Medium RUG's are RMX and RML.

Rehab Low. This is the most complex rehab level to attain. The Rehab Low levels are RLB, and RLA. Additionally, with extensive services the Rehab Low RUG's are RLX.

You may be asking what are the A,B,C's at the end of the RUG levels. These are related to the ADL needs of the resident. The X and L are similar, but indicate that the resident qualifies for extensive services AND has and ADL score higher than 6!

There are many components that make the nursing part of the Medicare RUG. Some are treatments that the resident has received in the past few days, to disease processes and diagnosis that the resident has. These items in different combinations create different Nursing RUG's

Extensive Services. SE3, SE2, SE1, (or SSA if ADL score <7)
Extensive services are services like IV medicaion, TPN and suctioning. There are other qualifiers to this nursing RUG category.

Special Care SSC, SSB, SSA (or CA1 or CA2 if ADL score <7)
Special Services are services like wound care, pressure ulcer care and other special care circumstances. There are other qualifiers to this nursing RUG category.

Clinically Complex CC1, CC2, CB1, CB2, CA1, CA2.
Clinically complex examples are dialysis, and oxygen. There are other qualifiers to this nursing RUG category.

Four ADL categories and how the resident performs in each of these categories help determine the Medicare RUG's. The ADL score helps determine the end score of all therapy RUG's. Lower ADL scores in Nursing RUG's cause a downward shift to the next lower category. The ADL score is one of the most important and most often missed component of the RUG.

The four ADL's that are used to help determine the RUG group are Toileting, Bed Mobility, Eating and Transfer. The resident is scored on how dependant they are and how many staff assist the resident in each of these categories