Hospice Cap Sequestration Group Appeal

Has Your Hospice Been Hit With a Hospice Cap Demand for Fiscal Year 2013 or 2014 Including Sequestered Dollars Never Received?

Who Is This For?
Any hospice provider who has received a hospice cap demand letter for fiscal year 2013 or later that includes sequestered payments.

What’s The Issue?
As you likely are aware, Medicare hospice payments were reduced by two percent in accordance with a sequestration order issued March 1, 2013, pursuant to Section 251A of the Balanced Budget and Emergency Deficit Control Act. You are also likely aware that Medicare imposes an annual aggregate cap on hospice payments and that fiscal intermediaries send out letters after the close of a fiscal year advising hospices whether their reimbursement has exceeded the cap and demanding return of any payments in excess of the hospice cap. What you may not know is that, in the most recent hospice cap demand letters (for FY 2013 and after), the fiscal intermediaries have included sequestered payments—payments that hospices never received—into the hospice cap calculation. In doing so, we believe the fiscal intermediaries have overstated the hospice cap liability.

How Can Hospices Fight Back?
In order to challenge the hospice cap demand, the provider must file an administrative appeal within 180 days of the date of the hospice cap demand letter. Hospice cap demand letters including sequestered dollars began going out in March 2015, so the deadline for many providers to initiate appeals of FY 2013 hospice cap demands began as early September 2015. We have already initiated group appeals on behalf of a number of providers.

Compared to the amount at stake, the cost to any provider of individually pursuing an appeal may be prohibitive given the potential multiple layers of appeal. This is particularly true in light of the inherent uncertainty of litigation. In such situations, providers may wish to consider other approaches, such as a group appeal.

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