Low Utilization Payment Adjustment (LUPA) rates were higher than expected in 2020, with home health organizations receiving lower reimbursements as a result.
There are tools available within a home health software that administrators can use to easily follow the billing changes in the Patient-Driven Groupings Model (PDGM). These tools will help providers avoid LUPAs.
Use a Case-Mix Analysis Tool
Since LUPA thresholds vary under PDGM, it is essential for home health organizations to accurately calculate the correct number of required visits in order to avoid a reduction in reimbursement.
After the Outcome and Assessment Information Set (OASIS) is complete, organizations can use the case-mix analysis tool to determine the correct threshold for both 30-day payment periods and projected revenue.
This tool also helps organizations maximize revenue in other ways. It offers a comorbidity adjustment (if any), shows HHRG scores under the Prospective Payment System (PPS) and PDGM to prepare organizations for proper patient coding and informs how secondary diagnoses will affect reimbursement.
Plan Periods of Care with the 30-Day Calendar
LUPA thresholds must be met within 30-day periods instead of the previous 60 days. Therefore, planning and monitoring care is crucial.
Use the 30-day calendar to schedule and monitor a patient’s entire care period, with missed visit, real-time visit and assessment statuses available. Alerts are built in to help organizations stay on top of PDGM deadlines, and LUPA risk alerts are provided to drive scheduling and care plan changes when necessary.
Find Clinicians to Fill Visits with Axxess CARE
Missed visits are an opportunity for LUPAs to occur.
Organizations will be alerted to missed visits using the 30-day calendar and will know to quickly find clinicians to complete those visits. Use the Axxess CARE staffing and scheduling app to easily find qualified clinicians in the patient’s area for visits as soon as the same day.
On the app, all required medical licenses are verified and background checks are performed on all clinicians, giving home health organizations peace of mind. Clinicians are rated from previous visits with other organizations to ensure the quality of care expected.
Up-to-the-Minute LUPA Monitoring
The increase in home health LUPAs has alarmed some healthcare professionals. These professionals have pinpointed the need for “up-to-the-minute understanding” of where each patient is with their LUPA threshold in order to maximize reimbursement.
With the threshold morphing from a set number in 60 days to 432 options in 30 days, organizations need to take advantage of the tools built into their home health software.
These features enable organizations to monitor patients up to the minute and will lead to the home health industry experiencing benefits originally intended with PDGM implementation.
Axxess Home Health, a cloud-based home health software, provides education and tools for organizations to succeed under PDGM. Axxess CARE, a home health staffing and scheduling app, is available across the United States for home health organizations and clinicians to connect and provide exceptional, timely care.
