Hospice Cap/Inpatient Day Limitation Calculator

This calculator can assist a hospice in determining the impact of the aggregate cap and inpatient day limit.

Limit 1: 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. 

Limit 2: Aggregate Cap on Overall Reimbursement    
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. 

View the Hospice Cap/Inpatient Day Limitation Calculator on our website.

Information on Input Fields

1. The beneficiary count is not the number of patients being serviced
2. Rather, it is the count (or sum) of each beneficiary’s allocation
3. The PS&R System provides Beneficiary Count Reports
4. The PS&R Summary Report has information on payments and visits