An Increasing Number of Hospices Will be Entitled to Cap Liability Refunds

The Health Group, LLC 

As more hospices become subject to claims denials and Medicare program repayments because of these denials, many hospices become eligible for refunds of CAP liabilities paid to the Medicare program.  Many of the claims denied are associated with patients who had longer lengths of stay during the terminal episode of care.  Accordingly, the denial of these claims generally decreases any historical CAP liability.

The Medicare Administrative Contractor (“MAC”) recalculates the hospice CAP liability based on their recalculation schedule but only for years they determine appropriate for recalculation.

The increase in claim reviews has resulted in more hospices being eligible for CAP liability refunds.  We have identified several hospices entitled to refunds for years which would not have been recalculated by the respective MAC.  In these situations, the hospice must request a recalculation.  We recommend that in these situations the hospice not only requests a recalculation but also provide the calculation supporting their refund request.

The MAC will not issue any refund of recovered CAP liabilities until the payment related to the claim denials has been recovered.