More Hospices Entitled to Cap Repayment Refunds

By The Health Group 

Hospices which have been subjected to claim denials and which have incurred CAP liabilities need to be keenly aware of refund opportunities to which they may be entitled.

Claims denials related to services rendered in a CAP Year for which a CAP liability occurred may entitle the provider to a partial refund of a CAP liability previously paid.  The denied claims triggering a repayment by the hospice may represent a second recovery of funds from the hospice and, accordingly, a partial refund of CAP repayments may be appropriate.

As claim reviews and denials become more prevalent, we see more potential CAP liability recoveries by hospices.  Depending on the CAP Year impact, the hospice may not be notified by the MAC of the recovery potential.  Hospices may need to request a refund to secure the excessive repayment to the Medicare program.