Home Health & Hospice Week

CMS backtracks on cap drop released earlier.

Hospices whose reimbursement is limited under Medicare's per-beneficiary cap are breathing a sigh of relief over their 2005 cap amount. But another cap problem still looms on the horizon.
 
The Centers for Medicare & Medicaid Services issued in an Aug. 19 transmittal (No. 655) a hospice cap for the year ending Oct. 31, 2005 of $18,963.47. That amount was more than $670 less than the previous year's cap (see Eli's HCW, Vol. XIV, No. 30, p. 236).
 
But a week later, CMS issued a revision to that transmittal (No. 663), setting the 2005 cap at $19,777.51. The change came after a flurry of questions and protest from hospices.
 
"Our members are pleased with the revision," Judi Lund-Person with the National Hospice and Palliative Care Organization tells Eli. "CMS discovered an error in their formula and made the adjustment once they discovered it."
 
Watch out: But possible changes to the 2004 cap still loom. CMS continues to say in its revised transmittal that it "incorrectly computed" the cap for the year ending Oct. 31, 2004, and will issue separate instructions on that problem.
 
The National Association for Home Care & Hospice estimates the 2004 cap should have been $18,963.47 - the amount CMS originally listed as the 2005 cap. "However, until CMS can evaluate the cap calculations, hospices should wait to apply the NAHC calculation in their operations," the association cautions.
 
"We've received a lot of questions and concerns from folks," CMS' Carol Blackford said in the Aug. 25 Open Door Forum for home care providers. "We're very aware of all of the concerns and issues ... with any sort of correction to the 2004 amount."
 
But a resolution for the 2004 cap problem still is unclear. CMS is conferring within its internal departments on the 2004 cap problem and its possible remedies, Blackford explained. "We hope to wrap up those discussions very quickly. And as soon as we do, we will be sending out those additional instructions."
 
CMS should be able to quickly perform the calculations, NAHC urges. Additionally, "any erroneous calculations in the past should not now create liabilities for hospices, since any overpayments resulting from such errors occurred without any provider fault," NAHC insists. 
 
Note: The revised transmittal is at www.cms.hhs.gov/manuals/pm_trans/R663CP.pdf.