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  • What Is LUPA in Home Health How it Affects Medicare Reimbursement
    If you fall short of that expected number of visits, your agency receives a significantly lower per-visit payment, not the full 30-day episodic payment So instead of being paid, for example, $2,500 for the full 30-day episode, you may receive a drastically reduced total, sometimes under $500 Before 2020, under the old 60-day episode Home Health PPS, a LUPA was any episode with 4 or fewer
  • Home Health LUPA Threshold: Bill Correctly | CMS
    In a recent report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5 to 7 visits in a payment episode Review the Medicare Home Health Benefit (PDF) and Home Health Prospective Payment System booklets to properly bill for services slightly above the Low Utilization Payment
  • How Can LUPA Be Avoided in Home Health? - Home Care Answers
    What is LUPA threshold in PDGM? We help Agencies learn how to avoid LUPA in home health and what low utilization payment adjustment affects reimbursement
  • LUPA Management in Home Health Care
    Many home health care providers are facing the increasing frequency of low-utilization payment adjustments (LUPAs) in the Patient-Driven Groupings Model (PDGM) environment and the Covid-19 pandemic has augmented it
  • Home Health LUPA Threshold Calculator - CGS Medicare
    Home Health LUPA Threshold Calculator Under the Home Health Patient-Driven Groupings Model (PDGM), each case-mix group is assigned a LUPA visit threshold to determine if a period of care receives a low utilization payment adjustment (LUPA)
  • What Is LUPA in Home Health - Strategies to Prevent LUPA
    LUPA stands for Low Utilization Payment Adjustment, a financial adjustment in the Medicare Home Health Prospective Payment System (HH PPS) It occurs when a home health agency provides fewer visits than the minimum threshold required for a specific patient’s billing period
  • CMS Posts Final CY 2025 HH PPS Payment Update Rule
    In the final rule, CMS projected a 1 7% decrease in payments for 2025, or about $280 million aggregate reduction compared to 2024 levels Within that proposal, there was also a permanent prospective adjustment to the CY 2025 home health payment rate of -4 067%
  • What is LUPA in Home Health? - worldviewltd. com
    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
  • Home Health Prospective Payment System: CY 2025 Rate Update
    We use the appropriate add-on factor (1 8451 for SN, 1 6700 for PT, and 1 6266 for SLP) to determine the LUPA add-on payment amount for 30-day periods of care under the PDGM
  • CMS Releases 2025 Home Health Final Rule Quality Update
    If a LUPA 30-day payment period is the first and only 30-day payment period, an additional LUPA add-on factor rate is applied that increases payment for the Start of Care visit only The add-on factor accounts for higher-than-average visit lengths for the Start of Care visit





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