Posts Tagged ‘LUPA’

CMS Proposes 1.5 Percent Cut to Home Health Payments

June 27, 2013

The Centers for Medicare & Medicaid Services (CMS) today announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2014 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Based on the most recent data available, CMS estimates that approximately 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18.2 billion in 2012.

In the rule, CMS projects that Medicare payments to home health agencies in calendar year (CY) 2014 will be reduced by 1.5 percent, or $290 million based on the proposed policies. The proposed decrease reflects the effects of the 2.4 percent home health payment update percentage ($460 million increase), the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($650 million decrease), and the effects of ICD-9-CM coding adjustments ($100 million decrease).

In addition, the rule proposes routine updates to the HH PPS payment rates such as updating the payment rates by the HH PPS payment update percentage and updating the home health wage index for 2014. (more…)

Manual Correction Required for Certain LUPA Add-Ons

November 20, 2012

CMS Says Agency Plans to Fix Problem

The Centers for Medicare & Medicaid Services recently responded to a request from the National Association for Home Care & Hospice to investigate a report that LUPA (Low Utilization Payment Adjustment) add-on payments are not made correctly in certain cases. Specifically, episodes are not being paid correctly when an agency projects 20 or more therapy visits in an early episode, but the patient is discharged from care after only four or fewer home health visits. In these cases the first digit assigned to the Home Health Resource Group (HHRG) is “5” and is defined as 20 or more therapy visits in an early or late episode. 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. (more…)

Palmetto GBA: Tips for LUPA Claims

October 26, 2012

Palmetto GBA released a fact sheet this week about Low Utilization Payment Adjustment (LUPA) claims for home health care providers. Keep in mind the following tips for low utilization claims for Medicare beneficiaries: (more…)