Healthcare Provider Solutions

Hospices are reminded that the Aggregate Cap calculation is due to their Medicare Administrative Contractor (MAC) no later than February 28, 2018. This is one month earlier than in the past due to the fact that the cap accounting year for both the inpatient cap and the hospice aggregate cap is being aligned with the federal fiscal year. Not only does this change the due date for the Aggregate Cap calculation it also changes the timeframes used for the calculation.

  • The beneficiary count period for the aggregate cap determination for hospices using the patient-by-patient method is from 11/1/2016 to 9/30/2017.
  • The beneficiary count period for the aggregate cap determination for hospices using the streamlined method is from 9/28/2016 to 9/30/2017, which is 12 months plus 3 days.
  • The payment period for the cap calculation for both the streamlined and patient-by- patient methods is 11/1/2016 to 9/30/2017. This is 11 months of payments.
  • For the inpatient cap, HH&H MACs are to calculate the percentage of all hospice days of care that were provided as inpatient days (GIP care and respite care) from 11/1/2016 through 9/30/2017 (11 months)

Even though the cap year is only 11 months, the aggregate cap amount is not prorated which may be beneficial for some hospices. Any hospice not submitting its aggregate cap calculation by the February 28, 2018 deadline is subject to suspension of its payments. The soonest a hospice can submit its calculation is December 31, 2017.

Each MAC has posted instructions on calculating the cap, completing the pro forma cap report, and filing the calculation. Click here for previous aggregate cap coverage from Healthcare Provider Solutions, Inc.

CGS
NGS
Palmetto