Home Health & Hospice Week

LUPA add-on to get more complicated.

Keep track of these tweaks to the home health prospective payment system to understand how 2014 rates will affect your bottom line.

To better cover Low Utilization Payment Adjustment (LUPA) costs, the Centers for Medicare & Medicaid Services proposes increasing LUPA amounts by 3.5 percent in addition to the usual inflation update (see chart, p. 186, for rate amounts), CMS says in the 2014 HH PPS proposed rule published in the July 3 Federal Register.

And instead of one LUPA add-on amount ($95.85 and $98.73 this year, respectively, for non-rural and rural areas), CMS proposes three different add-ons depending on whether the first visit was made by a nurse, physical therapist or speech therapist. The proposed LUPA add-on factors are 1.8714 for SN; 1.6841 for PT; and 1.6293 for SLP.

For example: "If the first skilled visit is SN, the payment for that visit would be $226.87 (1.8714 multiplied by $121.23)," the per-visit payment rate amount, CMS explains in the rule. The changes would result in a 4.8 percent increase to LUPA payments, CMS says in a release.

Don’t Overlook Supplies Reimbursement

CMS proposes a decrease in the Nonroutine Supplies (NRS) conversion factor of 2.58 percent in each year CY 2014 through CY 2017 (see related chart, p. 187).

Supplies are an area where reimbursement might be leaking through your fingers without you realizing it, suggests Pat Laff with Laff Associates in Hilton Head Island, S.C. Many agencies fail to record gross profit by discipline and supplies, Laff notes.