Hospices in the Palmetto regions have begun receiving FY 2013 cap demands that include sequestration (money never paid to the hospice) as a part of a cap revenue under CMS’ new policy.

Other MACs are expected to follow shortly.

CMS’ new policy to include sequestration appears to be unlawful and contrary to statute.  CMS declined to ask Congress to change the cap statute, declined to modify its own regulations, and even declined to issue a public Change Request.  Instead, CMS dictated this change privately to the MACs and let them announce the new “policy”.

If you receive an FY 2013 cap demand from your MAC, you will see that on the calculation page the MAC adds sequestration (money never paid) to revenue, thereby overstating hospice revenue and, in turn, overstating the repayment demand you will face.

Hospices must be alert.  Each hospice that receives an FY 2013 or FY 2014 cap overpayment demand from its MAC must file an appeal within 180 days of receipt of the demands from the MAC.

Because sequestered revenue as to any single hospice may be relatively modest, no single hospice on its own can justify both the administrative and Federal court litigation fees and costs that will be necessary to reverse this policy.

For these reasons, we are offering to represent hospices on an alternate fee and cost structure with the following basic terms:

Each provider will be charged a fixed upfront fee of the greater of $2,000.00 or ten percent (10%) of the amount by which revenue is overstated, plus $250.00 toward costs. No further fees or costs will be due unless we succeed in challenging the policy. We will need a group of minimum sufficient size.

If we save a provider money or recover money through this work, then the provider would pay a further fee equal to twenty-five (25%) of the savings at the time such savings are confirmed or realized, less fees already paid or fees and any costs recovered from CMS, with total fees regardless of benefit not to exceed $25,000 per provider in any case.