1. Determine the LUPA rate for each discipline for that patient's county on the end date of the episode.
-The LUPA rate can be found in Billing > PPS Billing > Edit PPS Episodes, enter the chart number and select the episode. Find the amount in the field LUPA $ Total.
- Or Reports > Billing > 13.20 HHRG/HIPPS Table. Select the correct county code and time frame and click on Print HIPPS $. LUPA rate for each discipline is located at the bottom of the report.
2. Calculate the total of the number of visits from each discipline x that LUPA rate.
-Find the number of visits per discipline from Billing > PPS Billing > Edit PPS Episode, enter the chart number and select the episode. The number of visits per discipline are at the bottom.
3. Calculate the Fixed Dollar Loss amount (each county has a fixed amount for each year).
-Find this number from Billing > PPS Billing > Edit PPS Episodes, pull up the patient and look in field Fixed $ Loss.
4. Get the expected $amount for the HIPPS code based on the total number of visits.
-Find this from Billing > PPS Billing > Edit PPS Episodes, enter the chart number and select the episode. The expected amount is in the field $ Expected.
5. Take the LUPA total (step 2) and subtract the Fixed Dollar Loss amount and the expected HIPPS $amount.
6. The outlier amount is 80% of the difference (assuming step 5 is > 0).