Home Health & Hospice Week

Some payment is better than no payment.

Normally, home health agencies try to avoid resource-draining low utilization payment adjustment episodes if at all possible. But sometimes LUPAs may be the best alternative to receiving no payment at all.

Why: If you keep the patient on for a full episode with no skilled need, your claim will likely wind up being denied much later on, said RN Sharon Litwin with 5 Star Consultants in Camdenton, Mo. Instead, discharge the patient while in the LUPA period, she suggested during the recent Eli-sponsored audioconference “Building a Strong Foundation in Homecare.”

Remember: According the Palmetto GBA website, “a LUPA is made for beneficiaries who require four or fewer visits during the 60-day episode. These episodes are paid the labor adjusted, national standardized, service-specific per-visit amount multiplied by the number of discipline-specific visits actually furnished during the episode.”

“A LUPA is a per-visit rate for those low-visit situations,” Litwin said. Use them in cases where you may have reason to visit the patient for a few visits, but you don’t see a need for a full episode.

Some patients may need a lower number of visits for such things as teaching the patient or caregiver to perform procedures or a condition which has stabilized quickly and does not have further skilled need. Discharging these patients during the LUPA period can prevent loss of reimbursement later on.