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Home Health LUPA Challenges Continue as Pandemic Subsides

The frequency of low-utilization payment adjustments (LUPAs) increased for many home health providers in the first year of the Patient-Driven Groupings Model (PDGM), which coincided with the COVID-19 crisis.

In part, that’s because there are far more LUPA variables to keep track of under the new payment model. At times, increases were also linked to home health patients unexpectedly declining scheduled visits because of COVID-19 fears.

To some, avoiding LUPAs by hitting a certain visit threshold may seem like a relatively simple process. But home health providers in the weeds are telling a different story.

“It’s probably one of the bigger challenges under PDGM,” Nick Seabrook, the managing director of BlackTree Healthcare Consulting, told Home Health Care News. “Under the Prospective Payment System (PPS), we had a single threshold. We had to manage five visits, and it was over 60 days. Now, you have 432 thresholds to try to manage, and it’s over 30 days. I think those two factors are what’s really driving LUPAs up.”

King of Prussia, Pennsylvania-based BlackTree Healthcare Consulting provides billing, OASIS and other services to home health agencies, among other post-acute care providers.

Home health companies were concerned about LUPAs prior to the onset of PDGM, whereas the Centers […]

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