Palmetto Hospice Reimbursement Rate Calculator
Estimated Reimbursement Summary
Adjusted Daily Rate: $0.00
Total Estimated Payment: $0.00
Understanding Palmetto GBA Hospice Rate Calculations
Hospice reimbursement under Medicare, specifically within the Palmetto GBA jurisdiction, is calculated using a formula that adjusts a national base rate by a local wage index. This ensures that providers in areas with higher labor costs receive appropriate compensation for their services.
How the Formula Works
The calculation splits the national base rate into two components: the Labor Share and the Non-Labor Share. Currently, for most hospice levels of care, the labor portion is approximately 66%. The steps involve:
- Base Rate Selection: Identifying the Level of Care (Routine Home Care, Continuous Home Care, Inpatient Respite, or General Inpatient).
- Labor Component Adjustment: Multiplying the labor portion (66%) of the base rate by the specific CBSA (Core Based Statistical Area) Wage Index.
- Non-Labor Component: Adding the remaining 34% (non-labor share) of the base rate which is not adjusted for geography.
- Unit Multiplier: Multiplying the resulting daily rate by the number of days of care provided.
The Core Levels of Care
- Routine Home Care (RHC): The most common level of care. Since 2016, RHC has a two-tiered payment system where providers receive a higher rate for the first 60 days of care and a lower rate for day 61 and beyond.
- Continuous Home Care (CHC): Provided during periods of crisis to maintain the patient at home. This is calculated on an hourly basis.
- General Inpatient Care (GIP): Provided in a hospice inpatient unit or a hospital for pain control or acute symptom management that cannot be managed in other settings.
- Inpatient Respite Care (IRC): Short-term inpatient care provided to the individual only when necessary to relieve the family members or others caring for the individual at home.
Example Calculation
Suppose a hospice provider in a region with a Wage Index of 1.1000 provides 5 days of Routine Home Care (Days 1-60).
National Base Rate: $218.33
Labor Portion (66%): $144.10
Non-Labor Portion (34%): $74.23
Adjusted Labor: $144.10 * 1.1000 = $158.51
Daily Adjusted Rate: $158.51 + $74.23 = $232.74
Total for 5 Days: $232.74 * 5 = $1,163.70
What is the CBSA Wage Index?
The CBSA Wage Index is a value assigned by Medicare to every county and urban area in the United States. It reflects the relative hospital wage level in the geographic area of the hospice as compared to the national average hospital wage level. Palmetto GBA providers must use the index specific to the patient's residence for Routine Home Care and Continuous Home Care, or the location of the facility for Inpatient levels of care.