No RAP LUPA (Low Utilization Payment Adjustment) invoicing

You can process a LUPA (Low Utilization Payment Adjustment) final claim invoice without first billing the RAP when you know beforehand that you are going to provide 4 or fewer visits for the episode (known as a “No RAP LUPA”). If you want to create a “No RAP LUPA” that will have 4 or fewer visits on the invoice:

  • It must be a payer that uses the PPS billing logic that will also accept a “No RAP LUPA” (i.e., Medicare is this type of payer)
  • The OASIS record for the episode must be completed and locked
  • You must have at least 1 scheduled visit verified for the episode to create the un-billed invoice
  • There must be 4 or fewer visits scheduled for the entire episode
  • The invoice status must be “Un-billed”

To create the “No RAP LUPA", use the following path:

  • A/R menu
  • Invoices option
  • Select “Un-billed” from the Invoice Type dropdown list
  • Select the “No RAP LUPA” link in the upper right corner of the invoice page
  • Select the OK button to confirm that you want to bill Final only. Invoice Status will now read: LUPA.

To use this feature effectively, you will want to include the RAP Review as part of the Payer Invoice Review Settings. This will stop all RAP invoices from being billed automatically, so that you can use this link to create the “No RAP LUPA” before the RAP is billed. To set up this Invoice Review Type use the following path:

  • Resources menu
  • Organization Payers option
  • Find/Select the Organization Payer
  • Select the Settings tab
  • Select the “Add Invoice Review Type” in the Payer Invoice Review Settings section
  • Check the box for RAP Review and enter a start date
  • Select the SAVE button

When you use this review type, you will have to check the RAP Review option from the “Payer Review/Release” link for each un-billed invoice to submit the RAP bill.

When processing the final claim, the “No RAP LUPA” invoice still needs to pass all the final claim edits, including all items checked on the Payer Invoice Review/Release pop-up.