TILE to RUG Frequently Asked Questions

What's this about forfeiting revenue?
As you know, Texas is in the process of converting from the Texas Indexed Level of Effort (TILE) system to Resource Utilization Groups (RUGs), similar to Medicare. As long as you're prepared, there shouldn't be any impact on your revenue. Our concern is that you may still have TILE based revenue in Accounts Receivable – if you delay too long, you may not be able to recover that revenue at all.

Don't I have the standard 365 day window to collect?
Yes, you still have one year. However, DADS and TMHP are both recommending that you process any TILE based claims by August 25th of this year in order to avoid payment delays.

Will I lose revenue because of the conversion?
Only if you have TILE related revenue in Accounts Receivable after August 24, 2009. The Department of Disability and Aging Services (DADS) will continue to accept Form 3652-A with Purpose Code E (Recovery of Lost Payment) until August 24, 2009. After that date, you will not be able to file for lost payment on TILE claims.

How can Merit help?
Merit's main line of business is Medicaid and Medicare Audit and Recovery. We analyze your Accounts Receivable and correct and re-file or appeal recoverable claims to ensure that you get the revenue that you deserve.

Can't my staff do this?
Maybe. But you should carefully consider the cost – what will your staff not be doing while they're pursuing AR? We're experts at this – it's what we do.

Tell me about “No Recovery – No Fee”.
Merit's audit and recovery services are performance based. We charge a percentage based on what we actually recover for you. If we don't recover, you don't pay.

How much does it cost?
Merit offers very competitive fees, and they are performance based – if we don't collect, you don't pay. Give a Merit representative a call now at 1.800.762.0279 to find out more.

How does it work?
Merit will review your Accounts Receivable and determine if we can help you based on your particular situation. If we believe we can help, we'll negotiate a services contract. Once we are linked as a biller for your provider number, we'll begin billing your AR.

What will you collect?
Merit will bill Medicare, Medicaid, and third-party insurance.

Will you collect private pay?
No. We don't collect private pay debt.

How long does it take to start seeing income?
You could begin to see deposits in as few as 10 days after Merit is set up and linked to your provider ID for billing purposes.

How long does it take to get setup?
Setup time depends on how quickly you can provide us with the information we need to get linked to your facility for electronic billing. However, it can usually be done in one work week.

If we didn't collect it, what makes you think you can?
You have revenue in Accounts Receivable for a variety of reasons, and some of it simply isn't collectable. However, a great deal of it usually is. We will tell you up front whether we believe we can help you or not. We have twenty years of experience to draw on when trying to recover revenue, and we are experts in this field. If your revenue is collectable, we will get it for you.

More About RUGs

When do RUGs go into effect?
September 1, 2008.

I heard that the RUGs conversion was delayed.
The most current information from the Department of Disability and Aging Services (DADS) is that RUGs will take effect on September 1, 2008, and that TILEs will be completely phased out by December 1, 2008.

Where can I get more information on the TILE to RUG conversion?
The Department of Disability and Aging Services (DADS) is the best source of information. They have set up a special website at www.dads.state.tx.us/providers/TILEStoRUGS/index.html to answer your questions.

Contact us: contactus@meritperformancesystems.com  or (866) 762-0279