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Review of Home Health Claims for Services With 5 to 10 Skilled Visits

If a home health agency (HHA) provides four or fewer visits from a skilled service provider that are included under home health coverage (excluding visits providing only services listed in 42 CFR § 409.49) in an episode, the HHA will be paid a standardized per-visit payment based on visit type. Such payment adjustments, and the episodes themselves, are called Low Utilization Payment Adjustments (LUPA). Once a fifth visit is provided, an HHA will instead receive a full 60-day payment based on episode of care. Since OIG has not reviewed payments for LUPA, we will review supporting documentation to determine whether home health claims with 5 to 10 skilled visits in a payment episode in which the beneficiary was discharged home met the conditions for coverage and were adequately supported as required by Federal guidance.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
June 2018 Centers for Medicare & Medicaid Services Review of Home Health Claims for Services With 5 to 10 Skilled Visits Office of Audit Services W-00-18-35813 2019