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News & Press: Hospice

Hospices Have Limited Time to Submit Aggregate Cap Report

Thursday, January 10, 2019   (0 Comments)
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January 10, 2019, NAHC Report 


The hospice self-determined aggregate cap reports and any overpayments are due February 28, 2019. Hospices have been completing their own cap reports and submitting them to their Medicare Administrative Contractor (MAC) since the 2014 cap year. If the MAC does not receive the hospice’s completed report by the due date of February 28, 2019, the MAC will suspend payments. If a hospice finds that it does have an overpayment but is not able to return the full amount back to Medicare by February 28, the hospice may be able to request an extended payment plan. Hospices should review their MAC’s instructions carefully for information about this. All hospices certified prior to October 1, 2017 are responsible for submitting the self-determined cap form in 2019 (for the 2018 cap year). Hospices certified after October 1, 2017 will be responsible for submitting the form in 2020 for the 2019 cap year.

To be clear, hospices can submit their self-determined cap form anytime between December 31, 2018 and February 28, 2019. Hospices may find it best to complete the form as soon as possible. Without getting into the details of the aggregate cap calculation, hospices should note that when a patient continues on hospice care, the proportional beneficiary count will tend to decrease with the increase in the total days of hospice care. As a result, the overpayment may increase the longer the patient stays on hospice care and may be different when re-calculated by the MAC.

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