Home Health LUPA Threshold: Bill Correctly

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

For more information, visit the Home Health PPS webpage and view these additional resources to stay informed on the latest policy and payment updates:

• Home Health PPS final rule
• Medicare Benefit Policy Manual, Chapter 7 (PDF) Section 10.6
• Medicare Claims Processing Manual, Chapter 10 (PDF) Section 10.1.17  
• Medicare Program Integrity Manual, Chapter 6 (PDF) (PDF) Section 6.2