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CMS RCS-1 Cheat Sheet by

CMS RCS-1
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Introd­uction

The long-term post-acute care (LTPAC) industry had a major change in 2018: Resident Classi­fic­ation System-1 (RCS-1). This new Medicare payment model RCS-1 has the potential to turn things upside down for providers that are not suffic­iently prepared.

The industry have become accustomed to the index maximizing system which incent­ivized higher therapy utiliz­ation. RCS-1 completely overhauls reimbu­rse­ment, comprising literally tens of thousands of unique daily rates based on countless different combin­ations.

1.RCS-1 Index Combining System

This approach financ­ially incent­ivizes lower therapy utiliz­ation. Every Medicare resident will receive a calculated case-mix score in each of four indexed compon­ents: PT/OT, SLP, NTA and Nursing. The four indices are then combined with a non-ca­se-mix component to determine reimbu­rse­ment. The therapy components will be determined by resident charac­ter­istics, not days and minutes as is currently the case.

2. RCS-1 Rates

Days one through 14 will be paid at 100 percent of the calculated rate.
Starting with day 14, and every third day therea­fter, the rate will be decreased by one percent.
The study preformed in 2015 indicated that residents required increm­entally less intensive services, and it was determined that the reimbu­rsement should reflect the decreased needs.

3. Group and Concurrent Minutes

Under the RUG system, group and concurrent minutes were possible; however, they provided some financial obstacles. Under RCS-1 this will be effect­ively reversed, and group and concurrent minutes will be incent­ivized. Individual minutes will be required to be at least 50 percent of the total minutes. Group and concurrent minutes will be capped at 25 percent respec­tively. With management oversight these changes will still allow for a lucrative profit margin.

4. RCS-1 Assessment Schedule

Upon admission to the facility, the MDS nurse will complete an Entry Tracker. The next assessment will be the 5-Day Assess­ment, which will be completed with Assessment Reference Date (ARD) on days one to eight of the stay. The 5-Day Assessment will be the only assessment needed until which time the resident is discha­rged. The only exception to this would be if the resident had a signif­icant change during their stay. If this occurs, a Signif­icant Change in Status Assessment (SCSA) will be required within 14 days of identi­fic­ation. Once the assessment is completed, the new calculated case-mix score will take effect on the ARD of the SCSA.
It should also be noted that if a resident is discharged to the hospital and returns to the facility within three days, no new 5-Day Assessment is required. Should the resident be out of the facility for greater than three days, a new 5-Day Assessment will be required upon their return.
 

RCS-1 Patient Driven Model

5. Diagnosis Codes

Diagnosis coding will be more important than ever. There will be specific weights given to diagnosis codes and these will be included in the comput­ation of the calculated case-mix score.

6. Activities of Daily Living (ADLs)

ADLs will continue to be included in the overall calcul­ation with one change: Bed Mobility will no longer be included in the calcul­ation. It will remain vital that ADL scores are captured and accurately documented during the assessment look back period. ADL docume­ntation should continue throughout the stay as a means to detect any signif­icant changes as well.

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