In SNF PPS, which classification system determines the case mix?

• A. Ambulatory Payment Classifications (APCs)
• B. Resource Utilization Groups (RUGs)
• C. Diagnostic Related Groups (DRGs)
• D. Severity Adjustment Modules (SAMs)

Answer: (B)

In SNF PPS, payment depends on how much resource use a resident requires. The system that groups residents by expected resource needs is Resource Utilization Groups. After a thorough assessment, the MDS data place a resident into a RUG category based on factors like nursing care minutes, therapy minutes, activities of daily living dependencies, cognitive impairment, and any special care needs. Each RUG category represents a different level of resource use, and the facility’s daily payment rate is adjusted accordingly through the case-mix index.

Ambulatory Payment Classifications are for outpatient services, not SNFs; Diagnostic Related Groups are used for inpatient hospital payments; and Severity Adjustment Modules aren’t the SNF classification approach. So the SNF case mix is determined by Resource Utilization Groups.