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PROVIDER REIMBURSEMENT REVIEW BOARD DECISION 2023D20PROVIDER Comfort brook Hospice LLC d/b/a Grace HospiceRECORD HEARING DATE October 18, 2022Provider No. 361703Fiscal Year 2020vs. MEDICARE CONTRACTOR
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How to fill out provider self-determined aggregate cap
How to fill out provider self-determined aggregate cap
01
Determine the total number of beneficiaries served
02
Calculate the total allowable costs incurred for providing services to the beneficiaries
03
Subtract any payments received from other sources for providing these services
04
Divide the remaining amount by the number of beneficiaries served to get the per capita cost
05
Fill out the provider self-determined aggregate cap form with the calculated per capita cost
Who needs provider self-determined aggregate cap?
01
Healthcare providers participating in capitated payment models
02
Organizations looking to manage costs and improve quality of care by setting a limit on total expenditures for a specific group of beneficiaries
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What is provider self-determined aggregate cap?
Provider self-determined aggregate cap is the maximum amount of services that a healthcare provider can provide or bill for within a specified period of time.
Who is required to file provider self-determined aggregate cap?
Healthcare providers who are subject to regulatory requirements and guidelines may be required to file provider self-determined aggregate cap.
How to fill out provider self-determined aggregate cap?
You can fill out provider self-determined aggregate cap by collecting and reporting all relevant information regarding the services provided by the healthcare provider.
What is the purpose of provider self-determined aggregate cap?
The purpose of provider self-determined aggregate cap is to ensure that healthcare providers are following regulations and guidelines while providing services to patients.
What information must be reported on provider self-determined aggregate cap?
The provider self-determined aggregate cap must include information regarding the services provided, the number of patients seen, and the total amount billed for these services.
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