Hospice Providers: Submit Your Self-Determined Cap by February 28th

For Medicare hospice providers, meeting regulatory compliance requirements and deadlines is essential for ensuring continued reimbursement. One critical annual deadline is the Self-Determined Hospice Cap (SDHC) report, due February 28, 2025, for the 2024 cap year.

Understanding the Hospice Cap

The hospice cap limits total Medicare reimbursement per hospice patient for a given fiscal year (October 1 – September 30). New hospices may have prorated calculations based on their certification date. To calculate the SDHC, hospices must access the Provider Statistical & Reimbursement (PS&R) System for beneficiary counts and reimbursement data. The cap can be determined using two allocation methods:

• Proportional Method (most used approach)
• Streamlined Method (available only in specific cases)

The Submission Process

Hospices must submit their SDHC report within five months of the cap year’s end. Late submissions may trigger a Past Due notice from the MAC and potential payment suspension.

To ensure timely submission:

• Access PS&R Reports – Download the PS&R Provider Summary Report and Hospice Beneficiary Count Summary reports to obtain required data.
• Complete the Calculation – Determine the total number of unique Medicare beneficiaries served and apply the fiscal year cap limit.
• Submit to Your MAC – Visit your Medicare Administrative Contractor (MAC) website for forms and instructions.

Post-Submission Process

Once submitted, the MAC will review the report for errors or discrepancies. If overpayments are identified, providers may receive an adjustment or overpayment notice. Prior years’ calculations may also be revised if material changes are found.

Don’t Risk Payment Delays—Act Now!

The February 28, 2025 deadline is fast approaching, and missing it could cause disruptions. Ensure your SDHC report is accurate, complete, and submitted on time to avoid penalties. If not already completed, start gathering your data now, review MAC guidelines, and take the necessary steps to stay compliant. Your proactive approach will help safeguard your hospice’s financial health and ongoing Medicare reimbursements.

About the Author

Keith Dapprich, Director of Clinical Consulting

Keith Dapprich, Director, joined McBee in 2015 and is a leader within the firm’s Clinical Consulting department, which serves the industry by providing services such as merger and acquisition (M&A) diligence support, clinical compliance reviews, medical denial reviews, hospice Cap services, corporate compliance reviews, and accreditation/survey assessment and preparation. Keith currently leads a team of analysts and senior analysts within the Clinical Consulting department, and he has a wealth of knowledge of the home health, hospice, and non-medical/private duty home care industries. Prior to joining McBee’s Clinical Consulting team, Keith held several positions on McBee’s Advisory Consulting team, providing financial, operational, management and revenue cycle consulting services to the post-acute healthcare industry. His expertise includes healthcare services M&A due diligence, revenue cycle operations, post-acute healthcare financial consulting and billing compliance, healthcare corporate compliance, Medicare hospice Cap analysis, and post-acquisition financial reconciliations.