For 2014, the national per visit amounts before wage index adjustments are found in the table below 2: In the event a LUPA episode occurs, the agency is not reimbursed “episodically,” but instead on a per visit basis. This includes visits by nursing, social work, home health aides, and physical, occupational, or speech therapy. It is important to note, however, that all billable visits, regardless of discipline, count toward meeting the visit threshold. As mentioned above, the LUPA episode occurs when 4 or fewer billable visits are performed. not “utilizing” much of our resources.) Accordingly, Medicare deems these episodes as necessitating a “payment adjustment.” Thus, we end up with the LUPA episode. Therefore, these episodes are “low utilization” (i.e. In a LUPA episode, the home health agency sees the patient for 4 or fewer total visits. In some instances, the “rules” we talked about above don’t apply. For 2014, the national standardized base fee for a 60 day episode is $2,869.27. That amount would reflect the acuity or “case mix” of the patient based upon the OASIS assessment and episode timing. In this instance, we would be reimbursed “episodically.” In other words, Medicare would pay us a set “episode” amount for our care. This would, of course, result in our agency performing quite a few patient visits – 19 in the above example. For example, a typical frequency and duration might be 1W9 for nursing and 2W5 for physical therapy. In many instances, one or more disciplines work together, and frequently we recertify our patients to meet their ongoing care needs.
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That said, let’s take a look at a “typical” episode of care in terms of reimbursement and then contrast that to the LUPA.įor most home health episodes of care, we generally see the patient for a series of weeks. However, the real significance of the LUPA comes into play in terms of how we are reimbursed for patient care. The term itself stands for “Low Utilization Payment Adjustment,” which seems simple enough. However, one acronym in particular – LUPA – seems to be a source of perpetual confusion for many of our clients. Indeed, we seem at times to speak a foreign language! Most of us in the home health industry have become familiar over time with the many acronyms used in our business – SOC, ROC, TIF, OASIS, HHRG, HIPPS, RAP, and many others. Unfortunately, her puzzlement at my response was not uncommon.
![lupa dubplate lupa dubplate](https://f4.bcbits.com/img/a2030097675_10.jpg)
“A LUPA?” she replied, seemingly puzzled. When I looked a little bit deeper at the claim, I spotted the reason for the discrepancy and explained that the patient’s episode was a LUPA.
![lupa dubplate lupa dubplate](https://f4.bcbits.com/img/a0777241487_10.jpg)
An updated version of this article explaining the PDGM impact on a LUPA is available here.Ī few weeks ago, a customer contacted our Support Center with a bad wintertime case of “billing confusion.” She had been reviewing her Medicare remittance advices and had noted that for one of her patients, she had received a reimbursement of only about $500, when, in fact, she had been expecting a reimbursement of around $2800. The new Patient-Driven Groupings Model (PDGM) takes effect January 1, 2020.