In March 2015, CMS instructed its contractors to add sequestered funds, amounts never paid to providers, to revenue for purposes of calculating the hospice cap. This results in cap repayment demands that are overstated, in that they require repayment of funds never received.

In the aftermath of this money grab, Sheppard Mullin has structured fixed-fee group appeals to reverse this policy.

In the six months since then, Sheppard Mullin has filed dozens of appeals on behalf of hospice providers with the Provider Reimbursement Review Board.

So far, these appeals relate exclusively to the 2013 cap year, the year in which sequestration first began (April 2013). Time is now running out for most 2013 appeals, so we urge you to review any such demands and consider your rights.  Providers have just 180 days (plus five for mailing) from the date of any letter to file an appeal.  For information on these appeals, please see here.

Meanwhile, on Thursday, October 29, 2015, Sheppard Mullin filed initial position papers with the Provider Reimbursement Review Board in three group cases. Counsel for the contractors (they must defend the CMS action), will file initial papers early in 2016.

Providers that do not file timely appeals will have no recourse regardless the outcome of these appeals.

Given that the FY 2015 cap year just closed, providers should now expect:

  • To begin to receive FY 2014 revised demands including sequestration. FY 2014 included a full year of sequestration, so more providers will be affected and to a greater monetary extent.
  • To receive revised instructions regarding FY 2015 mandatory reporting. There is suggestion that CMS will now require providers to include sequestration in their FY 2015 self-reports in February-March 2016.

We will continue to update our efforts to set aside this policy.