Question

True or False: Resource Utilization Groups (RUGs) compromise a case-mix methodology based solely on diagnosis and procedure codes submitted on Medicare bills.

Answer 1

Resource Utilization Groups (RUGs) do not solely rely on diagnosis and procedure codes submitted on Medicare bills.

Step-by-step explanation:

False:

Resource Utilization Groups (RUGs) is a case-mix methodology used in the healthcare industry, specifically in the long-term care setting, to determine the level of reimbursement for services provided to Medicare beneficiaries. While diagnosis and procedure codes are part of the information used to determine the RUG level, they are not the sole basis.

RUGs also consider factors such as the resident's activities of daily living (ADLs), therapy needs, and the overall complexity of care required. By considering multiple factors, RUGs provide a more holistic approach to assessing the resources needed for each resident.