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Home Health & Hospice Week

Medical Review:

Use These 5 Tips To Combat LUPA Denials

Published on Tue Aug 16, 2011

Do your LUPA stats stick out in comparison to your peers? With at least one HHH MAC focusing on LUPA claims for medical review, you should take a critical look at your own LUPA billing practices. Head off medical review problems with your low utilization payment adjustment claims by heeding this expert advice: Document, document, document. Under the prospective payment system, the intensity of medical review has diminished. Some experts argue that that has led to lower quality documentation on the part of clinicians. "Every note has to stand on its own," emphasizes consultant Betty Gordon with Simione Consultants in Westboro, Mass. You need to clearly show what skilled service you are providing and why it is necessary. For example: Teaching can be very important when a patient begins new meds, Gordon offers. Say a person with congestive heart failure is put on a diuretic, but doesn't like the side [...]
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