Home Health & Hospice Week

New LUPA-related edits may throw a wrench in your billing.

The problem: Under two billing-sequence-related circumstances, the Medicare claims system has been paying for multiple LUPA add-ons when episodes are adjacent (within 60 days of one another). That occurs when 1) an initial LUPA episode is auto-canceled when a later LUPA episode is submitted; and 2) the claims are processed out of sequence to begin with.

The solution: In the former case, instructions “change Medicare systems to identify the duplicate LUPA add-on payment before the earlier episode is canceled and to ensure the add-on is not paid,” explains a new MLN Matters article. In the latter case, new instructions “change Medicare systems to identify that a LUPA add-on has already been paid and return the earlier dated claim to the provider. The provider must then correct the admission date on the claim for the later dated episode before the earlier dated claim can be paid.”

See more details online at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9027.pdf.