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.
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LUPA Management in Home Health Care

• 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.
• 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?

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LUPA Management in Home Health Care
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. 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.
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LUPA Management in Home Health Care

• 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. For inquiries or assistance,
  please contact us at 888-357-3226 or Email us
  at info_at_medicalbillersandcoders.com.
•  
• FAQs
• 1. What is a LUPA used for?
• LUPA is used to adjust payments for home health
  care episodes with a low number of visits.
• 2. What is LUPA for home health?
• LUPA for home health refers to the adjustment
  made to payments for episodes of care with
  minimal visits.

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LUPA Management in Home Health Care
3. What does LUPA mean in Medicare? In Medicare,
LUPA stands for "Low Utilization Payment
Adjustment," which affects payments for home
health care services. 4. What does LUPA mean in
home health? In home health, LUPA refers to the
adjustment in payment for episodes of care with
fewer visits than expected. 5. What does home
health care mean in medical terms? Home health
care in medical terms refers to medical services
provided to individuals in their homes, typically
after a hospitalization or to manage chronic
conditions.