Hospice Bookkeeping Built Around the Medicare Cap
Booxmax is a bookkeeping, payroll, and advisory firm.
Per-patient-per-day books and beneficiary data kept current all year, so the figures your cost-report preparer’s cap determination needs are ready, not reconstructed in a year-end scramble. We keep the data. Your preparer determines the cap and files the report.
[ Book a 20-minute cap-and-books check ]
The cap you do not watch is the bill you cannot pay
Medicare pays hospice a flat rate per patient per day, then caps the total it will pay you in a year, per beneficiary. Cross that aggregate cap and every dollar over it is an overpayment you must return to Medicare. This is not a rare edge case: by federal estimates, close to one in five hospices exceed the cap, and federal audits have found cap overpayments in the hundreds of millions across providers. The danger is timing. When the data behind the cap is only assembled at year-end, a repayment can land as a cash crisis you never reserved for. The work is to keep that data current all year.
Per-diem revenue has to be tracked per patient, per day
Cap math is not something a normal monthly close produces on its own. It runs on per-patient-per-day figures and a beneficiary count that someone has to pull and keep current. We keep that data current each month, so the inputs your cost-report preparer needs to run your cap determination, your gross Medicare payments and your beneficiary days, are ready at any point in the year rather than reconstructed in February. We keep the data. Your preparer runs the determination.
Accrual books, so nothing is a year-end discovery
Hospice books belong on an accrual basis, so revenue and costs land in the period they actually belong to rather than when cash happens to move. That matters here because the figures behind a possible repayment build across the whole year. Accrual books, kept current, let you and your preparer see the trend early instead of meeting it at filing time. We also track your inpatient-care-day ratio month to month, so that data point is current too, not reconstructed at year-end.
Your cost report and cap report stand on these books
Inaccurate or late books produce an inaccurate cost report, and a poor or late filing invites payment suspension and audit exposure. We keep the numbers accurate and accrual. Your cost-report preparer files the cost report and the self-determined cap report from those numbers. Clean, current books are what let those filings hold up.
What we keep, every month
- Per-patient-per-day revenue and cost data, kept current.
- Accrual books, so revenue and costs land in the right period and the year-end trend is visible early.
- Beneficiary-day and inpatient-care-day data tracked monthly, as inputs for your preparer.
- Books reconciled to your remittances and Provider Statistical and Reimbursement data.
- Clinical-staff payroll (nurses, aides, social workers, chaplains, on-call, mileage).
- Cost-report-ready financials in QuickBooks Online by Certified ProAdvisors.
We never touch a plan of care
We track per-diem dollars and beneficiary days, not clinical days. Bookkeeping and payroll do not require protected health information, and we do not take it. Patient records stay in your clinical systems.
What we do, and what we don’t
We are a bookkeeping, payroll, and advisory firm. We do not run your cap determination, file your Medicare cost report or self-determined cap report, prepare tax returns, or give legal advice. Your cost-report preparer determines the cap and files both reports. Income tax routes to your tax preparer. Clinical records and PHI stay in your EHR. We keep the numbers those filings rely on.
Local, secure, QuickBooks-based
Certified ProAdvisors, a secure 256-bit SSL/TLS client portal, based in Burbank and serving the LA metro.
[ Book a 20-minute cap-and-books check ]
FAQ
What is the Medicare hospice aggregate cap? A yearly limit on what Medicare will pay your hospice, per beneficiary. Payments above it are an overpayment you must return. Keeping the data current all year is how the figure is never a year-end surprise.
Isn’t the cap my cost-report preparer’s job? Yes. Your preparer determines your cap and files the report, from your books. If the per-patient-per-day data and beneficiary counts are not kept current all year, that determination is the first time anyone sees a problem, when it is too late to plan for it. We keep the data current so your preparer can see it early.
Do you replace our CPA? No. We keep and reconcile the numbers all year; your CPA or cost-report preparer files. Two different jobs.
Do you handle our patients’ health information? No. Bookkeeping and payroll work from financial and payroll data only. PHI stays in your clinical systems.
Are you local? Yes. Booxmax, Inc., Burbank, CA, serving the LA metro.
This page explains general bookkeeping mechanics. It is not legal, tax, or cost-report or cap-determination advice. Medicare hospice cost reporting and cap determination route to your cost-report preparer; tax matters route to your tax preparer; clinical records stay in your EHR.
Booxmax, Inc. · 224 E Olive Ave, Ste 217, Burbank, CA 91502 · (818) 485-2669 · Info@booxmax.com · booxmax.com