Cms had projected that around 10% of all claims were loupes. There are several reasons for this, some include that patients did not want doctors to come into their homes for fear of getting sick. The Triple-Aim policy is focused on positive patient outcomes, positive experience of care, and a low per capita cost of care. As a result, Medicare pays HHAs a per-visit rate instead of a full episode rate. Over time, this can add up to a significant loss in revenue.
Educating workers internally on how LUPAs work is one thing, but external adjustments may be needed as well. © 2022 Homecare Homebase, LLC. Homecare Homebase and the circle mark are registered service marks of Homecare Homebase, LLC. All rights reserved. A federal government website managed and paid for by the U.S. A .gov website belongs to an official government organization in the United States.
LUPA Thresholds
At the time, providers had major gripes with a 1.9% increase in reimbursement that was substantially less than the 2.6% increase outlined in the proposed rule. Train your staff to always attempt to re-schedule visits or have a plan in place where other clinicians are available to make up visits with a patient. Get the latest news and business insights affecting home health, hospice and home care providers. Complex nursing with a visit threshold of two saw the highest LUPA rate, on average, of 22.5% Meanwhile the wound clinical grouping with a LUPA threshold of two saw the lowest LUPA rate of 4.9%. To some extent, LUPAs are gaining so much attention because the U.S.
Given the current acuity of its home health patients, EvergreenHealth hopes to lower its LUPA rate into the single digits by the end of this year. To Seabrook’s point, the behavioral adjustment from CMS did not reflect the reality that set in for EvergreenHealth, as well as other providers across the country. The adjustment was a proactive move on the agency’s part — not reactive.
LUPA management in-home health care
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Organizations should also, using the comprehensive SOC assessment, determine the need for additional disciplines and obtain orders quickly to support the patient’s needs. Remote patient monitoring will also be a vital tool to help manage the 30-day period. Identify patients who are at a high risk for hospitalization and carefully review utilization guidance and visit thresholds for these patients. These factors made it vital for agencies to look carefully at their data to understand why LUPAs are occurring and create strategies to avoid missed visits as much as possible.
What is LUPA?
Previously, agencies had to have more than 5 visits in an episode to avoid LUPA. PDGM changed the game on LUPAs and some agencies haven't adjusted well. Rather than being a fixed visit threshold, CMS changed the LUPA threshold approach to a sliding scale of visits based on a lot of other factors like coding, diagnosis grouping, OASIS . The new LUPA threshold is a sliding scale between 2 and 6 visits for each 30 day episode. With pdgm and home health in 2021, agencies have a lot to do. Pdgm started in 2020, but then a pandemic really got agencies’ attention, and understandably so.
When you talk about LUPA, It is one of the contractual adjustments that currently make up the Medicare-certified home health prospective payment system. However, PDGM provides an introduction towards building a better management team complex structure of visit requirement variables that Medicare home health care providers will need to navigate. King of Prussia, Pennsylvania-based BlackTree Healthcare Consulting provides billing, OASIS and other services to home health agencies, among other post-acute care providers.
Lupa Payments Home Health
Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen. Finally, in this era, a central and important aspect is case management while seamless collaboration and communication are gaining more and more importance. If you are looking for a medical billing company who can manage home health care billing then you are at the right place. Our experts will help you in this journey and you can rest assured. Here is an excellent link on handling loupe from homecare magazine.
This preparation includes conducting an intense review of your current LUPAs and understanding the impact that 30-day periods of care will have once PDGM is implemented in 2020. It will be no surprise to you by now that Low-Utilization Payment Adjustments can have a detrimental impact on home health agencies both clinically and financially. Clinically speaking, it is difficult to obtain the best patient outcomes with very few visits.
Under PDGM each of the case mix groups has a threshold to determine if the period of care would receive a LUPA. Payments for 30-day periods with a low number of visits are not case-mix adjusted, but instead paid on a per-visit basis using the national per-visit rates. You can’t miss out on the possibility where the first 30-day care plan with the additional visits might produce better outcomes and the second 30-day period may not be needed and a LUPA can be avoided.
A while ago, I received a call from a client who was very upset. She was upset that the reimbursement we had calculated for that patient was significantly higher than what the agency had actually received. Did the coding on her system match what was shown on our system? Did the doctor accept the suggested oasis changes we had made?
Barring any unforeseen circumstances, an administrator should expect that patient to result in a LUPA. An example of a non-avoidable LUPA is when a patient refuses any further care, or is readmitted to an acute care facility and never returns to the agency’s care. As you know, you can assess the detrimental impact of on agency including financial and clinical. The term itself stands for “Low Utilization Payment Adjustment,” which is a standard per-visit payment for episodes of care with a low number of visits. Currently, LUPA occurs when there are four or fewer visits during a 60-day episode of care. Under PDGM, the LUPA threshold will vary by HHRG and will be based on the 30 days of care.
Figure 1 shares a summary of the visit thresholds and related number of HHRGs and top clinical groups, under the current PDGM guidance as provided by Medicare. 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. First, understand factors that are causing LUPAs in your patient population well in advance of 2020. Your PDGM committee should begin now by randomly reviewing a percentage of LUPA episodes with varying diagnoses. Continue this review process monthly for the next three to four months.
For example, a patient could have a LUPA threshold of 4 in the first 30 days and 2 in the second 30 days. Agencies now know that you have to have more than 4 visits to avoid what we call LUPA land in the first 30 days. Is the patient is not discharged after 30 days, then the agency needs to make more than 2 visits in the second 30 days. Sometimes, a LUPA is inevitable, so it is important to consider the big picture as you think about your 2020 case-mix strategy. Under PDGM, with a 30-day period to assess and treat a patient efficiently, agencies front-load patients with three visits in the first seven days of care.
