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Beware LUPA Glitch For High Therapy Episodes
If you want to receive the roughly $95 you’re owed for a LUPA add-on amount when high-therapy cases end before five visits, you’ll need to submit manual adjustments -- at least for a while. So says the National Association for Home Care & Hospice.
Currently, when an agency predicts 20 or more therapy visits but the episode ends up being a low utilization payment adjustment with four or fewer visits, the system isn’t including the LUPA add-on that agencies should earn in addition to the per-visit payment amount. For an episode’s HIPPS code, "the current PPS Pricer does not recognize ‘5’ as eligible for LUPA add-on payments and does not autocorrect when an episode qualifies as a LUPA," NAHC explains in its member newsletter.
Unfortunately, it may be a while before CMS can correct the problem. It’s too late to fix the problem in the January pricer update, and another update may not come until January 2014 if there are no other problems to correct.
Meanwhile: "To receive the LUPA add-on, home health agencies must cancel and resubmit any early episode claims that projected 20 or more therapy visits that resulted in a LUPA," NAHC instructs. "Resubmitted claims should be assigned a HHRG for low therapy, early episode with a ‘1’ as the first digit in the HHRG," as opposed to a high-therapy HHRG that starts with "5."
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