Question: We have admitted a resident with insurance as their payer, and I need to complete the Admission MDS. However, I also need to get a RUG for the insurance billing, but I am being told I should not combine the assessments because they are only being used for insurance.

Answer: You should complete your Admission assessment and submit as required. The PPS MDS’s (5, 14, 30, 60, 90 day) will be required to be completed to obtain your RUG scores for the insurance company. They should be completed separately and not submitted. However, you can copy your Admission assessment to use for your 5 day, but do not submit to QIES what is not required, as this can be considered a violation of HIPAA.

For more information, please contact Celeste Rininger at 216-593-7143.