Your Hospice Is Over Cap. Now What?

Walters & Associates, CPAs: https://waltersaccounting.com Walters Billing Solutions: https://waltersbilling.com Walters Strategic Advisors: https://waltersadvisors.com What happens when your hospice is already over the Medicare aggregate cap? In Episode 03 of the Home Health and Hospice Profitability Podcast, host Doug Walters welcomes Lisa Rivard back for a follow-up conversation about one of the biggest financial concerns facing hospice agencies: hospice cap exposure. After receiving questions from their previous discussion on the Medicare hospice cap, Doug and Lisa take the conversation a step further and focus on what happens when an agency is already approaching or exceeding its allowable cap. Lisa discusses seeing more hospice agencies facing cap exposure, with demand amounts ranging from thousands of dollars to potentially millions depending on the individual agency and circumstances. In this episode, Doug and Lisa discuss: • Why hospice cap exposure continues to be a significant concern • The percentage of hospice agencies Lisa says are currently exceeding the allowable cap • The potential financial impact of exceeding the hospice cap • Why a large repayment demand can create serious cash-flow challenges • What hospice operators can do when they know a potential cap liability is developing • Why monitoring hospice cap exposure throughout the year matters • How monthly cap monitoring can help agencies understand changing exposure • Why monitoring shouldn't necessarily stop when the cap year ends • How patients who remain on hospice service can continue to affect prior cap periods • Why patients who transfer to another hospice may still affect an agency's cap calculations • The importance of continuing to monitor active prior cap periods • How cap monitoring can give hospice operators greater visibility into potential repayment exposure One of the key points in this conversation is that the end of a cap period doesn't necessarily mean an agency's exposure is completely settled. Lisa explains why her team continues monitoring not only the current cap period but also prior active cap periods when there are patients whose circumstances may continue to affect the calculation. For hospice owners and operators, understanding potential cap exposure before receiving a demand letter can be an important part of financial planning and cash-flow management. Rather than waiting until a potentially significant repayment becomes due, ongoing monitoring can help leadership understand where the organization currently stands and how that position may be changing. If you own, operate, manage, or advise a hospice agency, this episode provides an important follow-up to our previous discussion about the Medicare hospice aggregate cap. Subscribe to the Home Health and Hospice Profitability Podcast for more conversations about hospice operations, reimbursement, compliance, financial management, billing, profitability, and the business side of home health and hospice. #Hospice #HospiceCap #Medicare #HospiceBusiness #HospiceCare #HomeHealth #Healthcare #HospiceManagement #HospiceBilling #HealthcareFinance