Volume 23.04
There is substantial confusion regarding when overpayments determined by self-determined CAP liability filings are required to be paid. The regulations are clear that any CAP liability determined by self-filing is due at the time of filing; however, in practice, payment requirements are not so clear.
Regulations – CFR §418.308 states “The hospice must file its aggregate cap determination notice with its Medicare contractor no later than 5 months after the end of the CAP year and remit any overpayment due at that time.”
Many hospices that have self-determined liabilities make an extended repayment schedule (“ERS”) request relating to the payment of the self-determined CAP liability. Our experience indicates that the respective Medicare Administrative Contractors (“MACs”) are addressing self-determined CAP liabilities differently. The following should be helpful in addressing self-determined CAP liabilities.
Palmetto GBA
CAP liability payment is due with the self-determined CAP liability report. If payment is not remitted with the self-determined CAP liability report, a demand letter will be sent to the hospice; however, payment withholdings begin 15 days from the date of receipt of the self-determined CAP liability filing. Accordingly, if the hospice wants to request an ERS, we recommend that the request for ERS be submitted at the time of the self-determined CAP liability filing or shortly thereafter, but before any withholdings from payments would begin.
NGS
The NGS website includes, “If the self-reported CAP calculation indicates an amount due to Medicare, please make a check payable to NGS and submit it in a separate envelope…” However, if the hospice elects to request an ERS, NGS will not accept the request for ERS. NGS specifically responded to such request with, “If the provider has not received their demand letter, then they cannot submit an ERS. Please wait for the demand letter before requesting an ERS.”
It appears that a self-determined CAP liability filed with NGS will not cause a withholding of payments, until 15 days from such time as NGS has reviewed the submission and issued a demand letter.
CGS
Based on communication with CGS, payment of a self-determined CAP liability at the time of filing should be made; however, CGS will issue a demand letter and no withholding will occur other than described in the demand letter. CGS will accept a request for ERS without a demand letter.
CONCLUSIONS – Although hospices have filed their self-determined CAP liability filings for the 2022 CAP Year, all hospices should recognize that any CAP liability indicated at the time of the self-determined CAP filing is required to be paid at that time based on regulations; however, other options may be available. If your self-determined CAP liability submission indicates a liability, then:
- If your MAC is Palmetto GBA, pay the liability or request an ERS at the time of the submission or very shortly thereafter to avoid any withholdings.
- If your MAC is CGS or NGS, it appears you can make payment at the time of filing or wait to make payment or apply for an ERS when you receive the demand letter; however, you should secure confirmation from your MAC that waiting for a demand letter is acceptable prior to making payment or requesting an ERS. We recently submitted a self-determined CAP filing and included a statement that the Hospice will be requesting an ERS upon receipt of the demand letter.