Self-Determined Hospice Cap (SDHC) Report

Due Now:

Credit Balance Reporting now due for the Quarter ending 9/30/2023regardless of whether any credits need to be reported.

What to Submit:  The one-page Credit Balance Report – Form CMS-838.  Ensure that it is signed by an authorized representative.  It may be necessary to submit additional Credit Balance Report Detail pages.

When To Submit:  Due quarterly.  No later than 30 days after the end of the quarter.

How To Submit:  Report may be submitted by upload, faxed, or mailed.

Consequences of Late Submission:  If the Credit Balance Report is not submitted timely, payments may be withheld until the report is received.

Coming Soon:

Hospices are required to submit a Self-Determined Hospice Cap (SDHC) Report annually to the Centers for Medicare and Medicaid Services (CMS).  The SDHC Report covers a 12-month period from October 1^st to September 30^th, and this report helps CMS assess the impact of the aggregate cap on reimbursement for hospices.

What To Submit:  Only the one-page SDHC Report.  Do not include any supporting documentation.  Ensure that it is signed by an authorized representative.

When To Submit:  In January or February.  SDHC must be submitted no later than five months after the end of the Cap Year.

How To Submit:  CMS prefers submission by email.  Alternatively, reports can be submitted by mail.

Consequences of Late Submission:  If the SDHC Report is not received on time, payments may be suspended.

Repaying an Overpayment: If the SDHC Report shows payments exceeding the aggregate cap amount, an overpayment must be repaid.  Failure to repay may result in Medicare withholding payments to collect the amount due.  Payments can be made electronically via eCheck in the eServices portal.  Providers can request an Extended Repayment Schedule (ERS) if needed.  An initial payment and additional documentation are required with an approved ERS.

Reference:

Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 9, Section 90

Instruction – Completing the Self-Determined Hospice Cap (SDHC) Report (palmettogba.com)