Hospice Cap/Inpatient Day Limitation Calculator

This calculator can assist a hospice in determining the impact of:

The Aggregate Cap: Medicare payments are subject to an aggregate cap. The aggregate cap is calculated by multiplying the statutory cap amount (national rate) by the hospice's beneficiary count. Medicare payments that exceed the aggregate cap must be repaid.
The Inpatient Day Limit: Inpatient days are not to exceed 20 percent of total Medicare days. If inpatient days exceed 20 percent, payment for the excess days is reduced to the Routine Home Care rate.

Hospice Cap/Inpatient Day Limitation Calculator

Enter your data below. Estimated Number of Beneficiaries is not the number of patients being serviced, it is the count (or sum) of each beneficiary's allocation using the Streamlined or Patient by Patient Proportional method. The PS&R System provides Beneficiary Count Reports and the PS&R Summary Report has information on payments and visits.

Cap Year

Estimated Number of Beneficiaries

Total Medicare Payments

Routine Home Care Visits

Continuous Home Care Visits

Inpatient Respite Care Visits

General Inpatient Care Visits

Hospice Cap/Inpatient Day Limitation Calculator

This calculator can assist a hospice in determining the impact of:

The Aggregate Cap: Medicare payments are subject to an aggregate cap. The aggregate cap is calculated by multiplying the statutory cap amount (national rate) by the hospice's beneficiary count. Medicare payments that exceed the aggregate cap must be repaid.
The Inpatient Day Limit: Inpatient days are not to exceed 20 percent of total Medicare days. If inpatient days exceed 20 percent, payment for the excess days is reduced to the Routine Home Care rate.