LUPA management in-home health care

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LUPA management in-home health care
Many home health care providers are facing the
increasing frequency of low-utilization payment
adjustments (LUPAs) in the Patient-Driven
Groupings Model (PDGM) environment and the
Covid-19 pandemic has augmented it. Before
looking into LUPA management in-home health care,
lets understand what is LUPA is and when it
occurs? What is LUPA? 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. As you know, you can assess
the detrimental impact of (LUPAs) on agency
including financial and clinical. In the case of
clinical impact obtain the best patient outcomes
with very few visits is nearly impossible while
in the case of financial impact, a LUPA can be
the big difference between paying for an episode
of care and an adjusted payment.
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LUPA management in-home health care
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. LUPA management
probably one of the bigger challenges under PDGM
and in the following brief we will discuss
overcoming it. Measures for LUPA management
in-home health care Analyze and review your
current LUPAs As you have seen there is a
detrimental impact of (LUPAs) on the agency hence
it important to understand factors that are
currently causing LUPAs with your PDGM committee.
This PDGM committee should randomly review a
percentage of LUPA episodes with varying
diagnoses each month for the next three to four
months.
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LUPA management in-home health care

• The review process should include the following
• Causes of LUPA such as the result of missed
  visits, patient refusal of care, staffing issues,
  scheduling issues?
• Did the patient require more visits to meet goals
  and improve outcomes?
• Does the patients clinical picture match the
  visit utilization provided?
• Was homebound status confirmed correctly at SOC
  and was the patient-stated goal utilized to drive
  the plan of care?
• Were the right disciplines added at SOC/ROC?
• The above questionnaire in the review process
  will help you to analyze your results and
  identify whether the LUPA could have been
  avoided. You need to dig deeper to understand
  trends in avoidable versus unavoidable LUPA
  cases. Then, develop processes to correct
  avoidable LUPAs and educate your staff on these
  best practices for care.

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LUPA management in-home health care
Understand the impact of 30-day care plan You
cant 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. Moreover, the risk LUPA can cause within
the second 30-day period is easily tracked with
the help of past data of your organization. This
analysis will provide into which 30-day periods
and what types of episodes would fall into LUPA
categories in a PDGM environment. Now you
understand in the PDGM world LUPA just got
trickier but before the onset of PDGM, Home
health care companies were concerned about LUPAs
while the Centers for Medicare Medicaid
Services (CMS) thought different making it less
of an issue. 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.