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We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
The hospice cap period has changed and beginning with the 2017 report will end on September 30 of each year (previously the period for computing the hospice cap ended on October 31). The 2017 cap period began November 1, 2016, and ended September 30, 2017. The aggregate cap amount for the 2017 cap year is $28,404.99. The 2017 cap period is a transition year and the payments will be based on 11 months.
The impact of this transition on the periods used in counting beneficiaries and determining payment are noted below. The Self-Determined Hospice Cap (SDHC) form for 2017 is due on or before February 28, 2018.
Streamlined Method (SL) – 2017 Transition Period
Providers grandfathered into the SL method for counting beneficiaries are to report data (order PS&R reports) as follows:
Patient by Patient Proportional Method (PP) – 2017 Transition Period
All other hospices use the PP method and are to report data (order PS&R reports) as follows:
The Self-Determined Hospice Cap (SDHC) form for 2017 is due on or before February 28, 2018.
Please note the following:
The form to use for submitting the Self-Determined Hospice Cap (SDHC) is attached along with instructions. Be sure to complete all items and have it signed by an authorized representative. If the form is not received by the due date, a past due letter will be issued and payments will be suspended. Please file early to prevent payments being suspended!
The SDHC submission is required from all hospital-based and freestanding hospices for which Palmetto GBA processes claims. The cap for 2017 does not apply to hospices certified after November 1, 2016.
A final hospice cap review for the 2017 cap year will be performed and issued by Palmetto GBA. Also note that when a patient continues on hospice care, the proportional beneficiary count will decrease with the increase in the total days of care. As a result, the overpayment may increase from the amount initially determined.
Providers need to register in the EIDM system to have access to their PS&R data (Medicare Contractors are no longer obligated to provide PS&R reports that can be obtained by the provider). As noted above, we will be providing the data for use in submitting the Self-Determined Hospice Cap report. Providers with access to the PS&R are encouraged to access their own PS&R reports.
Submitting the Self-Determined Hospice Cap (SDHC) Calculation
What to send?
When to send?
How to send?
• Email to: HospiceCap@palmettogba.com
• Enter SDHC and provider number in the subject line
• Attached a scanned copy of the signed form
• A confirmation email will be sent upon receipt
• If unable to email, mail to either address:
Repaying an Overpayment (if applicable)
If the cap computation indicates an amount due the Medicare Program, please submit a check made payable to Palmetto GBA for the full amount (or the first month payment if requesting an ERS) and mail the check in a separate envelope to either of the following addresses. The payment can also be submitted using eCheck. eCheck is a feature of the eServices portal that allows providers to submit payments electronically. To register and utilize this feature, access our website and select the eServices link.
U.S. Postal Service
JM HHH Overpayments
Mail Code: AG-260
PO Box 100277
Columbia, SC 29202-3277
Requesting an Extended Repayment Schedule
If you are unable to repay the cap overpayment, you may submit documentation supporting a request for extended repayment. This documentation must be sent at the time of or prior to the submission of your cap computation to avoid withholding of your payments. The required documentation includes, but is not limited to, balance sheets, income statements, cash flow statements, and statements of source and application funds.
A copy of the check sent in as the first payment of the proposed repayment schedule must be included with the documentation. To obtain the 'Request for Extended Repayment Plan’ form and instructions, please access the Forms section of the Palmetto GBA website.
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Last Updated: 12/14/2017