Home Health Coding and OASIS Expert

When you get a referral for a patient who doesn’t qualify for a full episode of care, consider whether a Low-Utilization Payment Adjustment (LUPA) is appropriate.

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 Sharon Litwin. Instead, discharge the patient while in the LUPA period, she suggested during the recent Eli-sponsored audioconference Building a Strong Foundation in Homecare.

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. In cases where you may have a reason to visit the patient for a few visits, but you don’t see a need for a full episode, a LUPA may be appropriate.

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.