What is LUPA in Home Health?

The Patient-Driven Groupings Model (PDGM) was introduced in January 2020, but you might be taking the time to familiarize yourself with it now that healthcare is rebounding from the COVID-19 pandemic. One significant change PDGM has likely brought to your home health agency is the rise of complicated Low Utilization Payment Adjustments (LUPAs). PDGM has changed LUPA thresholds and now bases them on clinical grouping and episode timing. These changes may impact your revenue. 

Read on to learn more about LUPA in home health and how you can leverage it effectively in your business. 

What Is LUPA (Low Utilization Payment Adjustment)?

LUPA is a reduction in your reimbursement for treatment based on how many visits a patient makes to your care practice based on the threshold. Health services have different visit utilization thresholds based on potential patient outcomes. If a patient doesn’t meet the required number of visits, the Centers for Medicare and Medicaid Services (CMS) may reduce your reimbursement, potentially costing your care center a lot of money. 

Factors That Determine LUPA Status

With the right industry insights, including how LUPA status is granted, you can safeguard your health services agency from financial impact. The current LUPA ranges from two to six visits per 30-day payment period. The visit threshold is based on patient characteristics including the admission source, the patient’s clinical grouping, their functional impairment level, and their comorbidity adjustments.

The Impact of LUPA in Home Health

CMS implemented PDGM with the aim of paying home health claims more accurately based on patient characteristics and information. Clinical groups are based on common reasons patients may need home health services. The rationale behind this change is that patients typically receive better clinical outcomes when they visit health agencies more often in the first 30 days. 

Your health agency can reduce LUPA rates by becoming familiar with visit utilization thresholds and following Medicare guidelines. Consider automating and streamlining your internal processes to stay compliant. You can improve your revenues and enhance patient care.  

Improved Patient Care

Health agencies can improve patient outcomes with more effective treatment. However, you can’t treat patients who are not accessible or will not come to see you. With the new LUPA criteria, your agency may be more motivated to encourage patients to make all their visits in the first 30-day period. 

Creating a realistic plan of care and implementing practices like remote patient monitoring can help you effectively manage symptoms, which may reduce the overall cost of care. 

Reduced Costs and Increased Efficiency

As a home health care provider, you're required to notify a patient’s physician when they miss a visit. Sifting through a pile of paperwork and making these notifications manually takes time. Additionally, you run the risk of losing the file and your paper trail. Using an electronic content management system allows you to automate these notifications to stay in compliance and reduce your LUPA instances. 

Leverage the Power of Information and Stay Profitable

You can keep new LUPA thresholds from impacting your bottom line with proper home health documentation and accurate billing. WorldView’s solution makes healthcare finance easier by connecting your team to the information they need to do their jobs. Keep patient records, medication profiles, plans of care, referrals, and other documents in one location and coordinate information using apps. Add LUPA guidelines to your documentation system so your team knows the visit utilization threshold before treating each patient. 

Our strategic management tool allows you to provide the most effective care based on your patient’s health status and helps you stay in compliance with PDMG rules. Reduce your instances of LUPA and get paid based on how you treat patients. Find out more by scheduling a demo

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