tci Medicare Compliance & Reimbursement - 2011 Issue 20

Home Health Reimbursement: Get Ready To Defend Your LUPA Claims

Appealing LUPA claim denials is costly. If you haven't seen extra scrutiny of your LUPA claims yet, that's likely to change. Home Health and Hospice Medicare Administrative Contractor NHIC has been performing medical reviews of low utilization payment adjustment LUPA claims, which have fewer than five visits, the MAC reports in a message to providers. "Many denials have been identified in these reviews," NHIC says. The additional development requests (ADRs) on this issue are "driving people crazy" in New England, says consultant Betty Gordon with Simione Consultants in Westboro, Mass. Consultant Lynda Laff with Laff Associates in Hilton...

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