RUG Audits, Reconsiderations, Appeals, and Waivers


RUG Audits

- Resource Utilization Group (“RUG”) audits officially replaced TILE audits in 2008

- However, after two years of delay, RUG audits actually only began in the fall of 2010

- RUG audits are conducted by HHSC-OIG’s Utilization Review (“UR”) teams

- UR reviewers examine facility records on-site and look retroactively back to October 9, 2008

-Note that MDS 2.0 was the MDS version in effect when HHSC converted from TILES to RUGS in 2008; however, MDS 3.0 (the current version) went into effect in October 2010

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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