Senior woman in wheelchair pushed by nurse

All Medicare-certified hospice agencies are required to file a self-determined aggregate cap report by February 28, 2023 for the 2022 cap year. Medicare requires a full year of coverage for cap reporting; therefore, the initial cap calculations for newly certified hospices must cover a period of at least 12 months but less than 24 months. Therefore, newly certified hospice agencies that started during the 2022 cap year won’t need to file a self-determined aggregate cap report until February 2024, using a weighted-average cap amount for the 2022 and 2023 cap years, calculated based on the months in each cap year since the provider’s inception. This would apply to any providers certified during the period October 1, 2021 through September 30, 2022.

Provider Statistical and Reimbursement (PS&R) summary reports should be run to reflect the federal fiscal year October 1 through September 30. Likewise, beneficiary summary reports also should be run for the federal fiscal year, regardless of the beneficiary method used (streamlined or proportional). Keep in mind, the earliest date these reports can be run is December 31, 2022 to be accepted by Medicare.

The cap amount for the 2022 cap year is $31,297.61 per beneficiary, which is an increase of 2% from the 2021 cap amount. Any providers exceeding the aggregate cap will look to their corresponding Medicare Administrative Contractor (MAC) for instructions on the process and timeline for repayment of the cap liability. If necessary, providers may request an extended repayment plan option.

Providers are required to obtain the PS&R net reimbursement amount and beneficiary counts information directly through CMS’ Identity Management (IDM) system. If your agency needs to establish IDM and PS&R access, be sure to register now.

If you have questions or would like assistance preparing your hospice self-determined aggregate cap report, please reach out to a professional at FORVIS or submit the Contact Us form below.

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