CMS Announces Temporary Hold on Home Health LUPA Claims

Medicare System Correction Required.

Medicare contractors have identified an incorrect payment calculation affecting home health claims that would be paid low utilization payment adjustments (LUPAs).

To prevent these claims from paying incorrectly, Medicare contractors are holding all home health LUPA claims with “Through” dates on or after January 1, 2014 until Medicare systems are corrected. CMS is expecting this correction to occur in early February, 2014.

The LUPA add on rate is added to episodes that are the only episode or that are the initial episode where four or fewer visits are made. CMS introduced this in 2008 to help offset the administrative cost for shortened episodes which are more costly when they occur at the beginning of a patients care. This year, in lieu of a single LUPA add-on payment amount of $102.91, to ensure that the LUPA add-on amount equally reflects the excess cost for an initial visit for each of the three disciplines (SN, PT, and SLP), CMS finalized changes to multiply the per-visit payment amount for the first SN, PT, or SLP visit in LUPA episodes that occur as the only episode or an initial episode in a sequence of adjacent episodes.

The LUPA add-on factors are: 1.1.8451 for SN; 1.6700 for PT; and 1.6266 for SLP.

Please make sure your billing and administrative staff are aware of this delay in payment.