![]() ![]() Home health agencies have had a five-visit LUPA threshold for some time now with four visits or less per episode resulting in a low-utilization payment adjustment. Our experts will help you in this journey and you can rest assured.LUPAs are just one of the contractual adjustments that currently make up the Medicare-certified home health prospective payment system. If you are looking for a medical billing company who can manage home health care billing then you are at the right place. Now you understand in the PDGM world LUPA just got trickier but before the onset of PDGM, Home health care companies were concerned about LUPAs while the Centers for Medicare & Medicaid Services (CMS) thought different making it less of an issue.įinally, in this era, a central and important aspect is case management while seamless collaboration and communication are gaining more and more importance. This analysis will provide into which 30-day periods and what types of episodes would fall into LUPA categories in a PDGM environment. Moreover, the risk LUPA can cause within the second 30-day period is easily tracked with the help of past data of your organization. You can’t miss out on the possibility where the first 30-day care plan with the additional visits might produce better outcomes and the second 30-day period may not be needed and a LUPA can be avoided. Understand the impact of 30-day care plan Then, develop processes to correct avoidable LUPAs and educate your staff on these best practices for care. You need to dig deeper to understand trends in avoidable versus unavoidable LUPA cases. The above questionnaire in the review process will help you to analyze your results and identify whether the LUPA could have been avoided. Were the right disciplines added at SOC/ROC? Was homebound status confirmed correctly at SOC and was the patient-stated goal utilized to drive the plan of care? The review process should include the following:Ĭauses of LUPA such as the result of missed visits, patient refusal of care, staffing issues, scheduling issues?ĭid the patient require more visits to meet goals and improve outcomes?ĭoes the patient’s clinical picture match the visit utilization provided? This PDGM committee should randomly review a percentage of LUPA episodes with varying diagnoses each month for the next three to four months. ![]() Measures for LUPA management in-home health careĪs you have seen there is a detrimental impact of (LUPAs) on the agency hence it important to understand factors that are currently causing LUPAs with your PDGM committee. LUPA management probably one of the bigger challenges under PDGM and in the following brief we will discuss overcoming it. However, PDGM provides an introduction towards building a better management team complex structure of visit requirement variables that Medicare home health care providers will need to navigate. When you talk about LUPA, It is one of the contractual adjustments that currently make up the Medicare-certified home health prospective payment system. In the case of clinical impact obtain the best patient outcomes with very few visits is nearly impossible while in the case of financial impact, a LUPA can be the big difference between paying for an episode of care and an adjusted payment. Under PDGM, the LUPA threshold will vary by HHRG and will be based on the 30 days of care.Īs you know, you can assess the detrimental impact of (LUPAs) on agency including financial and clinical. Currently, LUPA occurs when there are four or fewer visits during a 60-day episode of care. The term itself stands for “Low Utilization Payment Adjustment,” which is a standard per-visit payment for episodes of care with a low number of visits. Before looking into LUPA management in-home health care, let’s understand what is LUPA is and when it occurs? Many home health care providers are facing the increasing frequency of low-utilization payment adjustments (LUPAs) in the Patient-Driven Groupings Model (PDGM) environment and the Covid-19 pandemic has augmented it. ![]()
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