Transition Claims

120.5 - Transition Claims (Rev. 4409, Issued: 10-04-19, Effective: 11-05-19, Implementation: 11-05-19) With regard to transition between RUG-IV and PDPM, a hard transition between the two systems has been implemented, such that days paid under RUG-IV would stop on September 30, 2019 and days would be paid under PDPM beginning October 1, 2019. In order to receive a RUG-IV HIPPS code that can be billed for services furnished prior to October 1, 2019, providers must use an assessment with an ARD set for on or prior to September 30, 2019. If the patient’s stay begins on or after October 1, 2019, then the provider would begin with the 5-day assessment, as usual. For patients admitted prior to October 1, 2019, but whose stays continue past this date, in order to receive a PDPM HIPPS code that can be used to bill for services furnished on or after October 1, 2019, providers must complete an IPA with an ARD no later than October 7, 2019 (i.e., transitional IPA): October 1, 2019, will be considered Day 1 of the VPD schedule under PDPM, even if the patient began their stay prior to October 1, 2019. Any “transitional IPAs” with an ARD after October 7, 2019, will be considered late and relevant penalty for late assessments would apply (described below).