Self-Determined Hospice Cap for 2017

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:

  • SL beneficiary reports with Beneficiary Identification Period of 9/28/16 through 9/30/17
  • Medicare payments for the service period 11/1/16 through 9/30/17.

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:

  • Beneficiary Identification Period of 11/1/16 through 9/30/17
  • Medicare payments for the service period of 11/1/16 through 9/30/17 

The Self-Determined Hospice Cap (SDHC) form for 2017 is due on or before February 28, 2018. 

Please note the following

  • Only send the one-page form (we do not need supporting information)
  • Be sure to sign the form
  • Preferred method of sending is via email
  • Send the scanned form to HospiceCap@palmettogba.com 

Comment: Palmetto GBA will be mailing to each hospice the data needed to complete the 2017 Self-Determined Hospice Cap (SDHC). This data as obtained from the PS&R system will include the Medicare Beneficiary Count, method for counting beneficiaries, and Net Payment. This information will be mailed in late January of 2018. It is not necessary to wait for this data, hospices can order their own PS&R reports. 

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?

  • Completed and signed SDHC form
    Only send the one page SDHC form (supporting documentation is not needed)  

When to send?

  • Send by February 28, 2018 (file early to ensure it is received by the due date!)

    If unable to file timely, a written request can be submitted prior to the due date to request a 50 percent payment suspension
Send by February 28, 2018 (file early to ensure it is received by the due date!)

How to send?     
 
• Email toHospiceCap@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:

U.S. Postal Service
Palmetto GBA
Attn: Hospice Cap Reporting 
Mail Code: AG-330
PO Box 100144
Columbia, SC 29202-3144
Courier Service
Palmetto GBA
Attn: Hospice Cap Reporting 
Mail Code: AG-330
2300 Springdale Drive, Building One
Camden, SC 29020-1728

  • Do NOT send both ways!

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
Palmetto GBA
JM HHH Overpayments  
Mail Code: AG-260
PO Box 100277
Columbia, SC 29202-3277 

Courier Service
Palmetto GBA
JM HHH Overpayments  
Mail Code: AG-260
2300 Springdale Drive, Building One
Camden, SC 29020-1728

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.

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

National Supplier Clearinghouse MAC

Anonymous

 


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