LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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Hospice Cap

The Fiscal Year (FY) 2015 Hospice Wage Index and Payment Rate Update included a requirement for hospices to file a self–determined hospice aggregate cap. Refer to the following topics for additional information.

Timeline

Hospices are required to file a self-determined cap no earlier than 3 months after, and no later than 5 months after the end of the hospice cap year, September 30. The earliest a hospice may file its self-determined cap is December 31, and the latest is February 28 of each year.

Terminated Providers

CMS now issues 2 years' worth of the Statuary Cap amount at a time, effect with the 9/30/17 Self-Determined (SD) cap submissions, CGS is making the following change in process for providers that have terminated from the program. Providers who have terminated from the program in the following cap year (i.e. 2021) to submit both Current Year (i.e. 2020) & their final (terminating) SD cap reviews at the same time. After CGS has completed processing the current year SD cap submissions we will complete all necessary final cap reviews for your agency. Statuary Cap Amount for 2022 is $31,297.61. Please note CGS must have received notice of & processed the termination before you can submit your final (terminating) SD cap.

Provider Statistical and Reimbursement (PS&R)

To assist hospices in preparing their cap calculation, hospices should obtain their Provider Statistical and Reimbursement (PS&R) summary and Hospice Cap reports from the CMS websiteExternal Website. Instructions are available to assist you in obtaining your PS&R reports.

CGS does not send copies of PS&R reports to hospices. Hospices are responsible for obtaining these reports direct from the PS&R System. However, hospices who are unable to obtain this information may contact Tom Bisbee, at 615.660.5560 for assistance.

Forms and Instructions

To complete your self-determined hospice aggregate cap, you must complete the "Provider Self-Determined Aggregate Cap Limitation"Microsoft Excel File form.

Instructions for completing this form are also available.

Calculation for Newly Medicare-Certified Hospices

The hospice aggregate cap is calculated in a different manner for new hospices entering the Medicare program, if the hospice has not participated in the program for an entire cap year. In this situation, the initial cap calculations for newly certified hospices must cover a period of at least 12 months but less than 24 months.

For example, the first cap period for a hospice entering the program on September 1, 2017, is from September 1, 2017 through September 30, 2018. When ordering your PS&R Summary and Hospice Cap reports you would use periods from agency's tie-in date to September 30 of second cap year. (i.e. using dates from above example September 1, 2017, thru September 30, 2018). To obtain the correct beneficiary count from the Hospice Cap report you would add together the count from the 2017 and 2018 cap years.

You will also need to calculate a prorated Hospice cap amountMicrosoft Excel File. Provider entry is required in all gray shaded boxes of this form.

Submitting Cap Determinations

Hospices should send their completed "Provider Self-Determined Aggregate Cap Limitation"Microsoft Excel Fileform along with a cover letter and all supporting documents to the following address:

Part A/HHH Audit & Reimbursement
CGS Administrators, LLC
PO Box 20015
Nashville, TN 37202

Or you can email to SDHOSPICECAPS@cgsadmin.com, or fax the above information to (615) 660-5983 Attn: Tom Bisbee.

IMPORTANT NOTE: If the self-determined cap is not received within 7 days of the end of February/1st few days of March due date, a Past Due letter will be issued and payments will be suspended.

Cap Overpayments

Any overpayment amount calculated as a result of the self-determined cap should be sent, along with a cover letter that explains what the payment is for, to the following address:

CGS
P.O. Box 957124
St. Louis, MO 63195-7124

Checks must be made payable to CGS.

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.

Receipt Confirmation

CGS will perform a cursory review of the filed self-determined cap for obvious errors upon receipt. 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.

Sequestration

The sequestration order, first issued on March 1, 2013, has been extended for services with dates of service or dates of discharge April 1, 2013 until further notice. For information about how sequestration amounts are handled pertaining to the hospice cap calculation, refer to the "Sequestration – Impact on Hospice Aggregate Cap Calculations" article. Please note that this article references dates based on the 2013 cap year; however the information applies to other cap years.

Updated: 09.29.21

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