From Barnestorm Office click on Reports > Billing > 18.03 PPS LUPA by ICD Codes

This report will show you a list of LUPA patients. The bottom of the report gives a total of episodes, and then shows the percentage of Anemia, Catheter, and Ostomy episodes. An A, C, or O will appear preceding the patients chart number if the ICD code relates to the Anemia, Catheter, or Ostomy code.

In searching for the LUPA reason, all ICD code descriptions are searched for the words Anemia, Catheter, or Ostomy.  Prior to August 2016, only the first 2 ICD codes were checked. 

LUPA episodes are paid on the national per-visit rate, per CMS:
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11536.pdf

How to Run the Report

From / Thru = Based on the bullet From Dates or Thru Dates that you select, this will pull episodes based on the From or Thru episode dates 

Program(s) / Team(s) = Filter report by entering program, and/or team. Or leave blank to select all. 

Medicare = Selects Medicare PPS episodes (Payer has PPS = Yes and Pay Class = B).

Non-Medicare = Selects non-Medicare PPS episodes (Payer has PPS = Yes and Pay Class not = B).

Both = Selects both Medicare and non-Medicare episodes.

Select how you want to sort the report. 

How to Read the Report

RFA = Reason for Assessment OASIS type. 

HIPPS = HIPPS code that was generated on the RAP claim.

ICD01 and ICD02 = Descriptions of codes related to LUPA. If this is blank, the ICD 1 or 2 history was modified and deleted from the 485 (these must match the codes used on the RAP). 

LUPA Reason = Reason from Billing > PPS Billing > Edit PPS Episode > Reason for not receiving full payment. 

D/C Reason = Discharge reason from the Referral.

Vx PT OT ST SN AI SW = Total visits; visits broken down by discipline.