Now that 2024 is here, hospice cap reports can be filed for the 2023 cap year. By the end of February, all Medicare-certified hospice agencies are required to submit a self-determined aggregate hospice cap report to your agency's Medicare Administrative Contractor (MAC) for the 12-month period from October 1, 2022 through September 30, 2023.
The only exception to this filing requirement is for new hospice agencies that became Medicare-certified during the 2023 cap year; in which case, the initial cap report will not be filed until February of 2025, as Medicare requires at least 12 months of coverage for a provider's initial cap reporting period. Likewise, if a provider became Medicare-certified during the 2022 cap year (October 1, 2021 through September 30, 2022), then the initial cap report will be due in February 2024 using a weighted-average cap amount for the 2022 and 2023 cap years based on the number of months since the Medicare certification date through September 30, 2023.
The statutory cap amount for the 2023 cap year is $32,486.92, a 3.8% increase from the 2022 cap amount. Under the predominant proportional method, a provider's aggregate cap amount is calculated by taking the statutory cap amount, multiplied by the number of proportional hospice beneficiaries served during the cap year, and then compared to the amount of Medicare payments paid relating to claims with dates of service during the cap year. Providers exceeding the aggregate cap will owe the excess back to Medicare and may request an extended repayment plan option if needed.
If you need assistance preparing your hospice self-determined aggregate cap report, contact a Home Care & Hospice industry advisor at FORVIS.