Goodbye RUG-IV, Hello RCS-1: How to Achieve Quality Outcomes Under a New Payment System - On-Demand

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Goodbye RUG-IV, Hello RCS-1: How to Achieve Quality Outcomes Under a New Payment System - On-Demand

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Goodbye RUG-IV, Hello RCS-1:
How to Achieve Quality Outcomes Under a New Payment System - On-Demand

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Available ON-DEMAND

Presented on:
Tuesday, January 16, 2018

Presented by:
Maureen McCarthy, BS, RN, RAC-MT, QCP-MT

Level of Program:

Earlier this year, CMS introduced the resident classification system, version I (RCS-1) in an Advance Notice of Proposed Rulemaking [CMS-1686-ANPRM]. The notice announced that the payment levels currently used in the prospective payment system (PPS), resource utilization group (RUG) IV, could be replaced as early as FY2019 by RCS-1. This is a complicated and significant change for providers. The majority of the changes that will occur with the implementation of RCS-1 are based on claims history and MDS data submitted. In order to understand and prepare for this shift, providers will need to learn how to achieve quality outcomes and higher reimbursement under a system that will offer different incentives.

During this 90-minute webinar, Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, will dive into the new payment system and review the steps providers need to take to achieve higher reimbursement. Attendees will also learn how to use the new case mix methodology of resident classification system and the new ADL scoring.

At the conclusion of this program, participants will be able to: 

  • Prepare for the shift to an episode-based payment system, and understand how to succeed post-shift by aligning incentives to optimize revenue and identifying clinical indicators to achieve higher reimbursement
  • Explain the new case-mix methodology of RCS-1
  • Explain new ADL scoring, clinical classification categories, and groupings called "condition categories"

Who Should Listen?

  • MDS coordinators
  • Rehabilitation staff
  • Directors of nursing
  • Administrative staff
  • Billers


  • Learning and preparing for a new payment system
    • Aligning incentives to optimize revenue
    • Identifying clinical indicators to achieve higher reimbursement under the new system
  • Relearning the new MDS schedule for Medicare Part A coverage
    • How will a significant change assessment interrupt payment?
    • Budgeting hours in the MDS department
  • Shifting focus to resident diagnoses and conditions rather than therapy minutes
    • Shifting focus toward accurate diagnosis and condition reporting rather than targeted number of therapy minutes as a result of rehab therapy services being built into all RCS levels
  • Finding the sweet spot for care and services robust enough to keep the resident out of a hospital for the 30 days post discharge while optimizing revenue
    • Rebranding restorative nursing to assist in therapy provisions
    • Best strategies for reviewing rehospitalization rates
  • Live Q&A


  • RCS-1 Model Calculation Worksheet for SNFs 

Meet the Speaker

Maureen McCarthy

Maureen McCarthy, BS, RN, RAC-MT, QCP-MT, is president of Celtic Consulting, LLC, and CEO and founder of Care Transitions, LLP, a care coordination service provider. She is also the creator of the McCarthy Method, a documentation improvement system for ADL coding. She and her associates at Celtic Consulting educate and train on clinical reimbursement, quality improvement, compliance, and coding for skilled nursing facilities, state affiliates, and provider organizations. McCarthy has been a registered nurse for 30 years with experience as an MDS coordinator, director of nursing, rehab director, and Medicare biller and holds a leadership role in several nationally recognized organizations. She has also authored multiple books for HCPro¾most recently she was the co-author of The Five-Star Quality Rating System Technical User’s Guide and the author of Medicare Audits: A Survival Guide for Skilled Nursing Facilities.

Webinar system requirements and program materials: 
To fully benefit from the webinar experience, please note you will need a computer equipped with the following:

Browser: Microsoft Internet Explorer 6 or later, Firefox, Chrome, or Safari, with JavaScript enabled 
Internet: 56K or faster Internet connection (high-speed connection recommended) 
Streaming: for audio/video streaming, Adobe Flash plug-in or Safari browser on iOS devices 

Prior to the webinar, you will receive an email with detailed system requirements, your login information, presentation slides, and other materials that you can print and distribute to all attendees at your location. 

No problem. The On-Demand version is now available. Use it as a training tool at your convenience—whenever your new or existing staff need a refresher or need to understand a new concept. Play it once or dozens of times. A $199 value! 

Participation in the webinar is just $199 per site. All materials must be retrieved from the Internet. 

Call your customer service representative toll-free 800-650-6787 or email if you have questions.