Home Health & Hospice Week

Pointer: Consider how visit management affects outcomes.

To ensure adequate reimbursement under PDGM, you must manage your Low Utilization Payment Adjustments.

Keep in mind, home health agencies will always have some LUPA visits, either based on individual patient clinical needs or situations where patients unexpectedly expire, transfer to a hospital or other provider, move out of the area, etc.

Key: “The HHA is never to decide the number of visits in order to prevent LUPAs,” stresses the forthcoming Home Health Certificate Course from the professional coding association AAPC.

But agencies should focus on avoiding those LUPAs which are unnecessary, experts urge. “Many clinicians are not thinking about their visit frequencies in terms of how they fall into two 30-day periods within an episode, or how the payment period cutoff dates in the middle of a week could produce an unintended LUPA simply due to visit timing during a seven-day period,” reports Sharon Harder, president of consulting firm C3Advisors in Wheaton, Illinois.

Or sometimes LUPA mistakes are due to mistakes such as inadequate intake information collection, missed visits, or scheduling errors. Those should be eliminated as much as possible under PDGM.

“It is essential to think about visit management in the 30-day periods of care,” emphasizes the AAPC Course authored by Sharon Litwin of 5 Star Consultants. Consider these questions for potential LUPA visits in a second 30-day period:

• Is low-visit count impacting clinical outcomes?
• Would moving those visits into the first 30-day period impact patient outcomes?
• Would the first 30-day period of care, with the additional visits, produce better outcomes?