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Home Health & Hospice Week

Industry Note:

Beware LUPA Glitch For High Therapy Episodes

Published on Thu Nov 29, 2012

If you want to receive the roughly $95 you're owed for a LUPA add-on amount when high-therapy cases end before five visits, you'll need to submit manual adjustments -- at least for a while. So says the National Association for Home Care & Hospice. Currently, when an agency predicts 20 or more therapy visits but the episode ends up being a low utilization payment adjustment with four or fewer visits, the system isn't including the LUPA add-on that agencies should earn in addition to the per-visit payment amount. For an episode's HIPPS code, "the current PPS Pricer does not recognize '5' as eligible for LUPA add-on payments and does not autocorrect when an episode qualifies as a LUPA," NAHC explains in its member newsletter. Unfortunately, it may be a while before CMS can correct the problem. It's too late to fix the problem in the January pricer update, and another update may [...]
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