Hospice Cap Reporting & Monitoring
Experience Counts! Transparent Pricing
- A Hospice must file its self-determined CAP liability “CAP Report” on or before February 28th.
- The earliest the CAP Report can be submitted is January 1st.
- Self-Determined CAP Liability Report Preparation.
- Monthly CAP Monitoring Service.(Peace of Mind)
- Great customer service starts with trusting your service provider. We want to make sure your experience with us is a positive one or we will refund 100% of your fees.
What is the Hospice CAP?
The Hospice CAP is a lifetime limit for each hospice patient. The individual beneficiary CAP is $29,205.44 for the 2019 CAP Year. The total Cap for each hospice is determined on an aggregate basis. This means that all patients are combined for each Cap year when comparing the total CAP. Stated another way, long term hospice patients over the CAP may be offset by those short-term patients that were under the cap and expired.
When is the Hospice self-determined CAP liability report due?
The CAP year coincides with the governmental fiscal year and runs from October 1 through September 30. Accordingly, a hospice must file its self-determined CAP liability (“CAP Report”) on or before February 28 (five months after the end of the CAP Year). The earliest the CAP Report can be submitted is December 31. (three months after the end of the CAP Year). We recommend pulling the Provider Statistical & Reimbursement Report as early as possible as that is the point in time that the liability will be lowest should one arise.
How are beneficiaries counted?
There are two methods for counting beneficiaries:
Proportional Method (applies to most hospices)
For each hospice, the count of the number of Medicare beneficiaries counted is the fraction which represents the portion of a patient’s total days of care in all hospices and all years that was spent in this hospice in this cap year (October 1 to September 30)
Under the Streamlined Method, when a beneficiary has received care from more than one hospice, each hospice includes in its number of Medicare beneficiaries only that fraction which represents the portion of a patient’s total stay in all hospices that was spent in this hospice in this cap year. The Streamlined method is only available to hospices that previously elected this method.
What happens if I’m over the CAP?
The excess payments will be recouped. Additionally, the liability will continue to increase until all patients are deceased. If a CAP liability exists, or is expected to occur when the self-reporting is prepared for submission to the MAC, the hospice needs to make an estimate of the ultimate CAP liability (the total final CAP liability for any CAP Year that results when all patients served during that CAP Year are deceased) that could result.
What makes us different?
We have the experience!
We have prepared hundreds of self-determined Cap liability reports and helped many clients prepare an extended repayment plan. Not one denial!
We know the business.
We have a very large healthcare clientele that we provide Audit, Tax, Payroll, and Compilation services to.
We make it extremely easy.
We know what we need and help you along the way.