For 2017, hospices landed on CMS’ Chance square and all hospices a ‘Get Out of CAP Free’ card!

Well, maybe it’s more like a ‘Get Out of One Month of CAP’ card. For 2017, hospices have a free month of Medicare payments vs. the beneficiary period. How?

Medicare Hospice CAP Calculation Specifics

In 2016 CMS announced it had changed its CAP year in order to—in their words—align the CAP year with the federal fiscal year. The CAP Rate and Year can be found in the federal register. There are two important items we wanted to highlight:

2017 Aggregate CAP Amount

• The per beneficiary aggregate CAP amount for the 2017 CAP year we’re currently in is $28,377.17: a 2% increase over last year.

2017 CAP Transition Year

• Because we’re in the ‘CAP Transition Year’ hospices essentially have one less month of payments counted towards CAP, meaning a hospice is slightly less likely to go over CAP this year because the CAP year is cut short by one month. (see Table 26 below).

The beneficiary period (a.k.a. admissions year) has historically been 9/28 – 9/27. I don’t know who came up with such odd dates. However, the 2017 CAP year changes to fiscal year ending 9/30/2017 and then will run 10/1 – 9/30 each year going forward. This means 2017 includes two extra beneficiary or admissions days. On top of this, the payments year has historically been 11/1 – 10/31 but is 11/1/16 – 9/30/17 this year and runs 10/1 – 9/30 going forward, which is one month less for 2017 to accommodate the transition. Hence the name ‘CAP Transition Year.’

This means that in 2017 you have not only two extra admissions days you also get one less Medicare payment month. This combination of two extra admissions and thirty-one fewer payment days adds up to 33 “free” CAP days in 2017. That is over a month’s worth of payments that won’t be counted against a hospice’s CAP this year: hence, if your organization would otherwise be just above CAP by less than 9%, instead you drew a ‘Get Out of CAP Free’ card from CMS’ Chance pile. Or if you were going to be significantly over CAP, you will likely see approximately an 9.04% reduction (33 days / 365 days) in your CAP overage.

Although this should be an easier CAP year, it’s June 1st, which means it’s time to check your CAP since we still have four months of admissions until we get to 9/30. If you’re over CAP, it’s not too late to correct your course before the CAP year ends.

Of course, we are always happy to look at your CAP numbers and advise you where you’re at. We work in most of the major hospice patient management systems, and some systems have built-in CAP reports while others require us to run reports and compile the numbers ourselves. We typically look at all our clients’ CAP about this time of year, but even if you’re not ‘in the family’ get in touch with us and we can help you determine where you’re at.

Source: Federal Register

Source: CMS News Release