Home Health LUPA Threshold: Bill Correctly

Mary Madison, RN, RAC-CT, CDP 
Clinical Consultant – Briggs Healthcare

In a recent report, the Office of Inspector General found that Medicare improperly paid some claims for home health services with 5–7 visits in a payment episode. Review the Medicare Home Health Benefit (PDF) and Home Health Prospective Payment System (PPS) (PDF) booklets to properly bill for services slightly above the Low Utilization Payment Adjustment (LUPA) threshold.

Visit the Home Health Prospective Payment System webpage for additional resources to stay informed about the latest policy and payment updates: