What is a Lupa in home health?
For periods of care beginning on or after January 1, 2020, if a home health agency provides fewer than the threshold of visits specified for the period’s HHRG, they will be paid a standardized per visit payment, or a Low Utilization Payment Adjustment (LUPA), instead of a payment for a 30-day period of care.
What is Lupa threshold in PDGM?
(Click on this link to see what OASIS questions PDGM focuses on PDGM OASIS questions) The new LUPA threshold is a sliding scale between 2 and 6 visits for each 30 day episode. This is important- this is for each 30 day episode.
What causes a lupa?
However, one cause of LUPAs stands out among the rest: the LUPA episode which occurs when a new home health patient is readmitted to an acute care facility and subsequently never returns to the agency’s care. Think for a moment about all the negative consequences which happen in those circumstances.
What are Medicare Lupa rates?
LUPA Visit Rates Medical Social Worker (MSW) went from $239.92 to $244.64. Occupational Therapy (OT) went from $164.74 to $167.98. Physical Therapy (PT) went from $163.31 to $166.83. Skilled Nursing (SN) went from $149.68 to $152.63.
What is an episode in home health?
Episode management is a continuous, proactive episode review process consisting of ongoing weekly analysis of open home care episodes. Key components include risk assessments, goals of care, analysis of visit utilization, discipline utilization, OASIS accuracy, and care plans.
What does Case Mix mean in home health?
Case Mix Diagnoses—Certain diagnoses were chosen by Medicare to contribute to the case mix or HHRG score. A casemix variable table indicates the number of points, if any, that diagnosis may provide in that particular equation (episode and therapy). Case Mix—term used to identify resource use for Medicare providers.
How many visits is a lupa?
A LUPA (Low Utilization Payment Adjustment) 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-day period of care.
What is a Lupa Lupa?
Remember, a LUPA occurs when there is one less visit than the pre-determined threshold and the LUPA threshold can vary from one 30-day payment period to the next. Be cautious when tapering visits during the second 30-day payment episode. The practice of tapering visits could inadvertently lead to a potential LUPA.
What is PDGM?
The Patient-Driven Groupings Model (PDGM) is the biggest change for home health agencies in over two decades. The transition to the new model requires agencies to examine patient needs, comorbidities, and referral sources to determine if their case mix optimizes reimbursement.
What is Medicare reimbursement rate for home health?
Effective January 1, 2021, the national standardized 30-day period payment rate will be $1,901.12 for a home health agency that complies with quality data reporting.
What is a partial episode payment?
● A partial episode payment (PEP) adjustment is made when a patient elects to transfer to another HHA or is discharged and readmitted to the same HHA during the 60-day episode.
What are the two admission sources?
Under the PDGM, each 30-day period is classified into one of two admission source categories – community or institutional – depending on what healthcare setting was utilized in the 14 days prior to home health admission.