Certified Revenue Cycle Representative (CRCR) Practice Exam

Who calculates the overall aggregate payments cap amount for hospices?

1. The Department of Health and Human Services (HHS)

2. The Medicare Administrative Contractor (MAC)

3. Each state's Medicaid program

4. The Center for Medicare and Medicaid Services (CMS)

The correct answer is: The Medicare Administrative Contractor (MAC)

The overall aggregate payments cap amount for hospices is calculated by the Medicare Administrative Contractor (MAC). This is because MACs are responsible for administering the Medicare program at a regional level, which includes overseeing the reimbursement processes for various services, including hospice care. They ensure compliance with regulations and policies set forth by federal agencies, particularly the Centers for Medicare & Medicaid Services (CMS). The cap amount is significant for hospices as it defines the maximum reimbursement they can receive under the Medicare program for patient care in a given year. The MAC uses established formulas and regulations to determine this cap, ensuring that hospices operate within the set limits to manage costs effectively while providing care. While the Department of Health and Human Services (HHS) and CMS play crucial roles in the overall regulation and establishment of healthcare policies, the actual calculation of the aggregate payments cap is specifically within the operational purview of the MAC. Each state's Medicaid program also does not calculate this amount, as they have separate guidelines and payment methodologies distinct from Medicare.