Hospice Providers to Self-Report Aggregate Cap Limitations

By: Michael Smith

CMS recently published the pro-forma spreadsheet and accompanying instructions for Hospice providers to self-report their aggregate cap limitation. Per 42 CFR §418.308(c):  
 

• The hospice must file its aggregate cap limitation notice with its Medicare contractor no later than five months after the end of the cap year (that is, by March 31) and remit any overpayment due at that time. Hospices shall file the aggregate cap using data no earlier than three months after the end of cap period (January 31).
   
• The Medicare contractor will notify the hospice of the final determination of program reimbursement in accordance with procedures similar to those described in §405.1803. If a provider fails to file its self-determined cap determination with its Medicare contractor within five months after the cap year, payments to the hospice will be suspended in whole or in part, until a self-determined cap determination is filed with its Medicare contractor, in accordance with §405.371(e).
   

FY2015 is the first year Hospice providers are required to self-report their aggregate cap limitation, but will be required to do so by March 31 of each year going forward.

Download the pro-forma spreadsheet and instructions. Any questions on completing the Hospice Aggregate Cap Limitation can be directed to your Eide Bailly Medicare Cost Report representative.