The self-reported Aggregate Cap calculation is due by February 28 for all certified Hospices. You are required to download the PS&R data from the system to use in calculating and self-reporting. The PS&R report should not have been printed prior to December 31, 2022 as you are required to wait three months after the end of the fiscal year before you print those reports. This allows time for all claims to be processed and all beneficiaries be included in those reports. The PS&R report is a vital part of this calculation.
Remember when self-reporting this information, your beneficiary calculations should include that patients have been spread across the entire time they have been on service. For example, if you had the patient on service for this past full year from 10/1 to 9/30, and they had been on service with you a full year prior to that, you would have counted 50% of a beneficiary in the current year’s calculation. The beneficiary cap amount is spread over the entire lifetime of the patient being on Hospice service, it is not a per-year calculation. For you to avoid having to refund money in the Cap calculation, ensure that you have enough short-term patients to make up for any long-term patients that you have, as the long-term patients may exceed the Aggregate Cap.
Another misunderstanding regarding the Cap is that if your patient exceeds $37,000, you must pay money back. That is not an individual patient-by-patient calculation, it is an aggregate calculation. Again, if you have enough short-term patients to make up for any long-term patients in the calculation, you would not technically owe back funds.
Do make sure to meet that deadline because if you don’t, within a few days after February 28, your payments will be suspended and you will not receive any payments with your Medicare claims processing until that Aggregate Cap calculation has been received in the Medicare MAC’s system. Each of the Medicare MACs have information regarding the Aggregate Cap on their website and there are forms that you can use to do your aggregate calculation and self-report.
If there’s anything HPS can ever do for you, please don’t hesitate to let us know.
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