Home Health & Hospice Week

It’s going to be a while until some LUPA-related claims processing problems get fixed.

Problems: “Low Utilization Payment Adjustment (LUPA) claims are processing with incorrect early/late episodes resulting in an incorrect payment” and “[LUPA] claims are incorrectly being sent to the Return to Provider (RTP) file because the Common Working File (CWF) believes a Request for Anticipated Payment (RAP) is needed. Reason codes affected are U5387 and U5391. Other reason codes, which begin with the letter U may also be affected,” HHH Medicare Administrative Contractor CGS details on its claims processing issues log.

Solutions: “A resolution to this issue is anticipated to be included in an upcoming Change Request for implementation in July 2021,” CGS reports for both problems. For the early/ late error, “once this issue is resolved adjustments will likely be necessary to correct the payment,” the MAC advises. For the RTP glitch, “until this issue is resolved, providers can submit a RAP for claims that receive the U5387 reason code,” CGS instructs. That goes for U5391 too, “or other possible reason codes that begin with a U.”