Other Issues

90.2.4 – Other Issues (Rev. 246, Issued: 09-14-18, Effective: 12-17- 18, Implementation: 12-17-18) The computation of the aggregate cap is made by the hospice after the cap year ends, which now is in alignment with the federal fiscal year. Hospices can obtain instructions regarding the cap determination method election process from their Medicare contractor. Regardless of which method is used, the Medicare contractor shall continue to demand any additional overpayment amounts due to CMS at the time of the hospice cap determination. Cap determinations are subject to the existing CMS reopening regulations, which allow reopening for up to 3 years from the date of the cap determination letter, except in cases of fraud, where reopening is not limited. If a provider’s covered days of hospice care or Medicare payments are adjusted through an audit or other review, the Medicare contractor may recalculate the aggregate cap if the amount is material.