Hospice Knowledge Center
What is the hospice aggregate cap?
The Medicare hospice aggregate cap is one of two annual caps that limit Medicare hospice payments. Long-length-of-stay hospices and those with high-utilization patient mixes are most at risk of exceeding the aggregate cap.
Aggregate cap, in one sentence
The aggregate cap equals the annual per-beneficiary cap amount multiplied by the (weighted) number of Medicare hospice beneficiaries the hospice served in the cap year. Payments above that ceiling are subject to repayment.
The per-beneficiary cap amount
CMS sets the per-beneficiary cap amount annually, indexed to a percentage of the hospice payment update. The amount is published in the Federal Register hospice wage-index final rule each year.
How the weighted beneficiary count works
When a beneficiary is served by more than one hospice in a cap year, each hospice claims a fractional share of that beneficiary equal to the proportion of hospice days provided. This is the "weighted" or "proportional" count.
How to prevent an over-cap year
Track your cap position monthly (see our free Aggregate Cap Modeler). Balance short-length-of-stay admissions with your long-length-of-stay patients. Investigate any single-hospice patient counts that trend materially below prior years. Discuss cap position with leadership every quarter, not just at year-end.
Frequently asked questions
What happens if we exceed the aggregate cap?
Is there also an inpatient cap?
When is the cap year?
Sources & further reading
Educational content only. Not a substitute for your organization’s policies, your medical director’s clinical judgment, or current CMS guidance.
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