November 18, 2020
Hospice Self-Determined Cap Changes
NOTE: If CGS does not pay your agency’s Medicare claims, we are not responsible for the Hospice Cap work for your agency. The MAC that pays your claims is whom you need to submit your SD Cap to & to ask any questions you may have.
The Centers for Medicare & Medicaid Services (CMS) has made a change to include/add the ACO Demonstration Reduction amount from the PSR summary report to the Reimbursement amount used to calculate the Hospice Cap determinations. ACO Demo Reduction can be found under Post-Sequestration Demo Reduction line of the PSR Summary report. (see below for example)
This change applies only to the Self-Determined Aggregate Cap submissions. CGS uses the Gross Reimbursement amount in our calculations, which would include this amount.
In above example, you would add both amounts together and input on line 4 of the Pro-Forma form.
Please contact Tom Bisbee at (615) 660-5560 if you have any questions regarding above changes or Hospice Cap questions in general.