The Department of Medical Assistance Services (DMAS) is moving forward with the switch from the current RUG-III 34 grouper to the RUG-IV 48 grouper for dates of service beginning on July 1, 2017.  Keep in mind that the six CCC Plus managed care organizations (MCOs) will begin coverage after the switch to RUG-IV has occurred (Tidewater is scheduled to go live August 1).  Therefore, claims readiness testing with the six MCOs should theoretically be under the RUG-IV 48 grouper.

DMAS has informed VHCA that it is working on a Medicaid Memo that will discuss the transition and billing process information.  We have specifically asked how claims for dates of service prior to July 1, will be paid after July 1 (as they would be submitted under RUG-III).   We anticipate that the DMAS memo would explain this scenario and others.  We will relay any information as soon as it is available.  In the meantime, nursing centers need to be adding the RUG-IV 48 capability to their billing systems.

We would anticipate that this testing will begin in the next couple months; therefore, the timeline for adding the RUG-IV 48 capability may be shorter than anticipated if you plan to test.

Additionally, VHCA is looking into an education program outlining the differences in the RUG-III and RUG-IV groupers in the near future – more to come!