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. Before looking into LUPA management in-home health care, let’s understand what is LUPA is and when it occurs?

What is LUPA?

The term itself stands for “Low Utilization Payment Adjustment,” which is a standard per-visit payment for episodes of care with a low number of visits. Currently, LUPA occurs when there are four or fewer visits during a 60-day episode of care. Under PDGM, the LUPA threshold will vary by HHRG and will be based on the 30 days of care.

As you know, you can assess the detrimental impact of (LUPAs) on agency including financial and clinical. In the case of clinical impact obtain the best patient outcomes with very few visits is nearly impossible while in the case of financial impact, a LUPA can be the big difference between paying for an episode of care and an adjusted payment.

When you talk about LUPA, It is one of the contractual adjustments that currently make up the Medicare-certified home health prospective payment system. However, PDGM provides an introduction towards building a better management team complex structure of visit requirement variables that Medicare home health care providers will need to navigate.

LUPA management probably one of the bigger challenges under PDGM and in the following brief we will discuss overcoming it.

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Measures for LUPA Management in Home Health Care

Analyze and review your current LUPAs

As you have seen there is a detrimental impact of (LUPAs) on the agency hence it important to understand factors that are currently causing LUPAs with your PDGM committee. This PDGM committee should randomly review a percentage of LUPA episodes with varying diagnoses each month for the next three to four months.

The review process should include the following:

  • Causes of LUPA such as the result of missed visits, patient refusal of care, staffing issues, scheduling issues?
  • Did the patient require more visits to meet goals and improve outcomes?
  • Does the patient’s clinical picture match the visit utilization provided?
  • Was homebound status confirmed correctly at SOC and was the patient-stated goal utilized to drive the plan of care?
  • Were the right disciplines added at SOC/ROC?

The above questionnaire in the review process will help you to analyze your results and identify whether the LUPA could have been avoided. You need to dig deeper to understand trends in avoidable versus unavoidable LUPA cases. Then, develop processes to correct avoidable LUPAs and educate your staff on these best practices for care.

Understand the impact of 30-day care plan

You can’t miss out on the possibility where the first 30-day care plan with the additional visits might produce better outcomes and the second 30-day period may not be needed and a LUPA can be avoided. Moreover, the risk LUPA can cause within the second 30-day period is easily tracked with the help of past data of your organization.

This analysis will provide into which 30-day periods and what types of episodes would fall into LUPA categories in a PDGM environment.

Now you understand in the PDGM world LUPA just got trickier but before the onset of PDGM, Home health care companies were concerned about LUPAs while the Centers for Medicare & Medicaid Services (CMS) thought different making it less of an issue.

Finally, in this era, a central and important aspect is case management while seamless collaboration and communication are gaining more and more importance. If you are looking for a Medical Billing Company who can manage home health care billing then you are at the right place.

Our experts will help you in this journey and you can rest assured. For inquiries or assistance, please contact us at: 888-357-3226 or Email us at:


1. What is a LUPA used for?

LUPA is used to adjust payments for home health care episodes with a low number of visits.

2. What is LUPA for home health?

LUPA for home health refers to the adjustment made to payments for episodes of care with minimal visits.

3. What does LUPA mean in Medicare?

In Medicare, LUPA stands for "Low Utilization Payment Adjustment," which affects payments for home health care services.

4. What does LUPA mean in home health?

In home health, LUPA refers to the adjustment in payment for episodes of care with fewer visits than expected.

5. What does home health care mean in medical terms?

Home health care in medical terms refers to medical services provided to individuals in their homes, typically after a hospitalization or to manage chronic conditions.

Published By - Medical Billers and Coders
Published Date - May-21-2021 Back

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