Abstract

Edited by Rita Munley Gallagher, PhD, RN, C

Nurses in Skilled Nursing Facilities (SNFs) are now both the sources of care and the primary revenue determiners for facilities. Since 1987, the American Nurses Association has been advising the Health Care Financing Administration (HCFA) on the impact on nursing of a prospective payment system (PPS) for skilled nursing facilities. The system that is now law places considerable trust in the nursing profession. Registered Nurses' assessment of SNF residents is the basis for determining which residents are eligible for the Medicare Part A Skilled Nursing benefit and at which payment level the SNF will be paid for each resident's care. The purpose of this independent study module (ISM) is to assist nurses in gaining new knowledge to be able to explain the new prospective payment system for long term care, the implications for nurses and residents, and their responsibilities in the process.

Objectives

Upon successful completion of this module the learner will have the ability to:

• Detail relevant aspects of the PPS system.
• Explain the relationships between the minimum data set (MDS) and the Resource Utilization Group (RUG).
• Identify the MDS elements used to calculate the RUG-III category.
• Describe both opportunities and challenges for registered nurses under PPS.
• Discuss ways to increase the accuracy of the MDS.