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Printed Date: 9/22/2015
The form labeled "Provider Self-Determined Aggregate Cap Limitation" is attached.
The form is only one page. The top section contains the cap computation. The lower section contains the certification statement. Be sure to complete both sections. Please note the following related to submitting the self-determined hospice aggregate cap for the period ended September 30, 2018.
Also note that when a patient continues on hospice care, the proportional beneficiary count will tend to decrease with the increase in the total days of hospice care. As a result, the overpayment may increase from the amount self-determined. A final hospice cap review for the 2018 cap year will be performed and issued by Palmetto GBA, and will incorporate any self-determined hospice cap overpayment and sequestration amounts.
New this year: Providers will be required to obtain their own PS&R data in order to complete the Self-Determined Hospice Cap report. We will not be furnishing this data to all providers as in previous years. If you do not have access to the EIDM system, you should register now. Information about registering can be found on the CMS website.
The cap for 2018 only applies to hospices certified on or before October 1, 2017. The first cap period for providers certified after October 1, 2017, is the 2019 cap report and will be due February 29, 2020.
If you have any questions, please send them to us via email at HospiceCap@Palmettogba.com.
Submitting the Self-Determined Cap Calculation
What to send?
When to send?
How to send?
Email to: HospiceCap@palmettogba.com. Reference only your Provider Number in the subject line.
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 and ERS) and mail the check to either of the following addresses. The payment can also be submitted using eCheck. eCheck is a feature of the eServices portal, where one can submit payments electronically. To register for and utilize this feature, access our website and select the eServices link.
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 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: 02/19/2019