Hospice Cost Report — CMS-1984-14 and the Cap
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The Hospice cost report is the annual Medicare filing every Medicare-certified hospice submits to its MAC on Form CMS-1984-14. Beyond the usual cost reconciliation, it computes the hospice aggregate payment cap — the regulatory ceiling on how much Medicare will pay a hospice in a year (42 CFR § 418.309).
The cap is what makes the hospice report different
A Home Health report ends at settlement. A hospice report adds two limits. The aggregate cap (§ 418.309) caps total Medicare dollars: the per-beneficiary cap amount for the cap year times the hospice's Medicare beneficiary count. The inpatient cap (§ 418.308) limits inpatient care to 20% of total Medicare patient days. Exceeding either produces an amount the hospice must repay Medicare — which is why the cap arithmetic, not just cost finding, drives the hospice settlement.
How the cap calculation works
The aggregate cap is a single comparison: the year's published per-beneficiary cap amount multiplied by the hospice's Medicare beneficiary count, set against total Medicare payments for the cap year. The beneficiary count uses one of the two methodologies in § 418.309 (streamlined or proportional), and the choice affects the result when patients receive care across multiple cap years. costreporting.ai runs both the cost finding and the cap determination deterministically, shows the cap exposure before filing, and traces every input — so the repayment number is never a surprise at audit.
Common questions
What is the hospice aggregate cap?
The aggregate cap (42 CFR § 418.309) limits total annual Medicare payments to a hospice. The cap is the statutory cap amount for the year multiplied by the number of Medicare beneficiaries the hospice served. If total Medicare payments exceed that limit, the hospice repays the difference.
How is the hospice cap calculation done?
Multiply the published per-beneficiary cap amount for the cap year by the hospice's number of Medicare beneficiaries (counted using either the streamlined or proportional methodology under § 418.309). Compare that figure to total Medicare payments for the cap year. Payments above the limit are an overpayment the hospice must return.
What is the difference between the aggregate cap and the inpatient cap?
They are two separate limits. The inpatient cap (42 CFR § 418.308) limits inpatient days to no more than 20% of a hospice's total Medicare patient days. The aggregate cap (§ 418.309) limits total Medicare dollars. Both are tested on the cost report.
When is the hospice cost report due?
Five months after the end of the hospice's fiscal year (42 CFR § 413.24(f)(2)). The cap year itself runs October 1 through September 30; the cost report reconciles the provider fiscal year and computes the cap determination.
Sources
- Regulation:42 CFR § 418.309 — Hospice aggregate cap
- Regulation:42 CFR § 418.308 — Limitation on the amount of payments (inpatient cap)
- Regulation:42 CFR § 413.24 — Adequate cost data and cost finding (filing at § 413.24(f))
- CMS Manual:Provider Reimbursement Manual, Part 2 (Pub. 15-2) — CMS-1984-14 instructions