{"id":627,"date":"2019-03-08T16:42:56","date_gmt":"2019-03-08T16:42:56","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=627"},"modified":"2019-03-08T16:42:57","modified_gmt":"2019-03-08T16:42:57","slug":"cap-sequestration-math-may-be-hard-to-beat","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2019\/03\/08\/cap-sequestration-math-may-be-hard-to-beat\/","title":{"rendered":"Cap Sequestration Math May Be Hard To Beat"},"content":{"rendered":"\n
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Should under- and over-cap hospices be treated the same?<\/em><\/strong><\/p>\n\n\n\n

Hospices may have a tough time fighting Medicare\u2019s cap calculation in court, experts agree.<\/p>\n\n\n\n

\u201cThis decision does not help those hospices that have had cap liabilities calculated in prior years,\u201d notes hospice accounting expert\u00a0Ted Cuppett<\/strong> with\u00a0The Health Group\u00a0<\/strong>in Morgantown, West Virginia. \u201cI wish they could have prevailed,\u201d Cuppett says of the recently handed down\u00a0Provider Reimbursement Review Board\u00a0<\/strong>decision endorsing the\u00a0Centers for Medicare & Medicaid Services\u2019\u00a0<\/strong>use of sequestered funds in the hospice cap calculations.<\/p>\n\n\n\n

CMS\u2019s lack of communication and clarity about the topic has led to a lot of confusion, judges consultant Lisa Lapin <\/strong>with Simione Healthcare Consultants <\/strong>in Sturbridge, Massachusetts.<\/p>\n\n\n\n

But the methodology laid out in the PRRB decision shows how if CMS doesn\u2019t use the sequestered amount in cap calculations for the roughly 14 percent of providers that exceed their cap amounts, those hospices would be unaffected by the 2 percent sequestration reduction.<\/p>\n\n\n\n

Hospices under their cap amounts have their payments reduced by their payment rates, which are calculated with the 2 percent payment reduction for sequestration, Cuppett explains. But hospices over their cap amounts do not see that same reduction because they just receive their cap amount. \u201cHospices over their cap lose nothing\u201d due to sequestration, he illustrates.<\/p>\n\n\n\n

That\u2019s why CMS and its contractors use the sequestered funds in the calculation, the PRRB explains in its decision.<\/p>\n\n\n\n

\u201cI would have loved it\u201d if the hospices would have secured a favorable PRRB decision, Cuppett says. But CMS\u2019s math does hold\u00a0up,\u00a0if the intent of sequestration is to reduce all hospices\u2019 payments by 2 percent.<\/p>\n\n\n\n

The math \u201cseems clear,\u201d says Lapin, who \u201cdoesn\u2019t feel there\u2019s a strong case for a different methodology.\u201d<\/p>\n\n\n\n

Cuppett hopes the plaintiffs may find policy grounds on which to contest their overpayments, he says.<\/p>\n\n\n\n

Source- SuperCoder<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Should under- and over-cap hospices be treated the same? Hospices may have a tough time fighting Medicare\u2019s cap calculation in court, experts agree. \u201cThis decision does not help those hospices that have … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":628,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,5],"tags":[32,12],"class_list":["post-627","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-hospice","category-reimbursement","tag-capreport","tag-hospice"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/627","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=627"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/627\/revisions"}],"predecessor-version":[{"id":629,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/627\/revisions\/629"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/628"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=627"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=627"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=627"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}