Filing Your 2018 Hospice Cap Report

Presenters/Authors
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If you haven’t yet filed your 2018 hospice self-determined aggregate cap report, there are a few things you should know. First, the due date is right around the corner—February 28, 2019. This due date was implemented last year; however, it’s one full month earlier than in years before. Also implemented last year was an updated cap reporting period. The hospice cap year now aligns with the federal fiscal year beginning October 1 through September 30. Provider Statistical and Reimbursement (PS&R) summary reports should be run to reflect this period. Likewise, beneficiary summary reports also should be run for this fiscal year, regardless of the beneficiary method used (streamlined or proportional). Keep in mind, though, the earliest date these reports can be run is December 31, 2018, to be accepted by Medicare. The cap amount for the 2018 cap year is $28,689.04 per beneficiary, and any providers exceeding the aggregate cap will need to submit payment to Medicare by February 28 as well. If necessary, providers may request for an extended repayment plan.

Medicare requires a full year of coverage for cap reporting. Therefore, newly certified hospice agencies will need to file a self-determined aggregate cap report in 2020 using a weighted-average computation for the 2018 and 2019 cap years for the months in each cap year since the provider’s inception. This would apply to any providers certified after October 1, 2017.

Providers who have Palmetto GBA as their Medicare Administrative Contractor (MAC) also should be aware that the PS&R net reimbursement amount and beneficiary counts will no longer be provided to them by Palmetto GBA as in prior years. Providers will be required to obtain this information directly through the Enterprise Identity Management (EIDM) system. If your agency needs to establish EIDM and PS&R access, be sure to register now.

Further instructions for completing and submitting the hospice self-determined aggregate cap report can be found at each of these MAC websites:

If you have questions or would like assistance preparing you hospice self-determined aggregate cap report, contact Eimee or your trusted BKD advisor.


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