Eli's Hospice Insider

Published on Mon Mar 16, 2015 PDF

Follow your MAC’s instructions to submit hospice cap by March 31.

How exactly sequestration will affect your ultimate cap amount for 2014 is up in the air, but your duty to submit your self-calculated cap figure is not.

Getting your cap info in by March 31 is possible now that all three Home Health Medicare Administrative Contractors have posted instructions to hospices on how to do so.

Palmetto GBA: Palmetto was the quickest on the draw when it came to posting information on how to submit your cap. It’s also the only MAC that issued the PS&R reports necessary for the calculating to every hospice preemptively. Find information at http://palmettogba.com/palmetto/providers.nsf/docsCat/Jurisdiction 11 Home Health and Hospice~Resources~Audit and Reimbursement — scroll down to the “Self-Determined Hospice Cap Calculation” article.

NGS: Illinois hospices won’t report their cap amounts to National Government Services, the MAC says on its website. For those hospices that do report their cap to NGS, the MAC will send a confirmation letter within 45 days of receipt. “When applicable the confirmation letter will also serve as a demand letter for providers with an amount due the Medicare Program,” the MAC explains. “NGS will also perform a cursory review of the submitted self-determination for obvious errors within 60 days of receipt.”

NGS has indicated to the National Association for Home Care & Hospice that it will consider sending PS&R data on a case-by-case basis upon request, the trade group reports.

Instructions for calculation and submission are at http://cgsmedicare.com/hhh/financial/hospice _caps.html — scroll down to the “Hospice Cap: Self-Reporting Instructions” article.

CGS: “If the self-determined cap is not received within 7 days of the March 31st due date, a Past Due letter will be issued and payments will be suspended,” CGS warns on its cap website at http://cgsmedicare.com/hhh/financial/hospice_caps.html.

“CGS will perform a cursory review of the filed self-determined cap for obvious errors upon receipt,” the MAC says. “Hospices will receive a letter from CGS to confirm receipt of the filed self-determined aggregate cap calculation within 45 days of receipt. CGS will perform a final review of the filed calculation at a later date.”

Plus: “If the overpayment is not submitted at the same time as the self-determined aggregate cap, CGS shall demand the overpayment reported on the self-determined aggregate cap,” the MAC warns on its website.