April 2, 2020
CMS recognizes that the current regulation on moonlighting residents will not adequately meet the needs of teaching hospitals during this Public Health Emergency (PHE). The current regulation limits moonlighting to services outside the resident’s approved GME programs to patients in an outpatient department or emergency department of a hospital in which the resident has...Read More
March 31, 2020
CMS released a document outlining temporary regulatory waivers and new rules issued by the Trump Administration to provide the healthcare system with maximum flexibility to respond to the COVID-19 pandemic. The temporary changes will apply immediately for the duration of the emergency declaration. Several of the temporary regulatory changes impact the hospital’s Graduate...Read More
March 24, 2020
Amid the unusual circumstances caused by COVID-19, we understand the concerns many providers have relating to extensions on filing cost reports and resident rotations. To date, there have been no regulation changes or exceptions announced by CMS but we will continue to monitor this closely.
As your news source for everything related to GME Reimbursements, we encourage...Read More
January 14, 2020
Breaking Down the GME Payment: Per Resident Amount explained important factors in the Direct Graduate Medical Education (DGME) payment formula. This article will take a step further and discuss another important factor in the Medicare DGME payment, a hospital’s Medicare utilization.
Medicare DGME Payment Formula
The Medicare DGME payment reimburses teaching...Read More
December 11, 2019
Medicare Graduate Medical Education (GME) regulations have many exceptions and special circumstances hospitals must consider when filing their Medicare cost reports. One special circumstance is when a resident takes a leave of absence.
As explained in IRIS Reporting Breakdown, teaching hospitals are required to submit their Intern and Resident Information System...Read More
November 5, 2019
GME Solutions has over 20 years of experience working with Medicare auditors (i.e. Medicare Administrative Contractors, or MACs). The most common disallowances made by MACs concerning Graduate Medical Education (GME) payments result from resident elective rotations.
What are Elective Rotations?
Elective rotations provide an opportunity for residents to tailor...Read More
September 24, 2019
Medicare payments to hospitals for services performed are reported in the hospitals annual cost report. This cost report accounts for all expenses the hospital had for the previous fiscal year, including costs for Graduate Medical Education. This article will explain the statutory deadlines and steps hospitals take to receive proper Medicare payments.
August 14, 2019
CMS has made available its display version of the FY 2020 IPPS Final Rule, which is scheduled to be published on August 16, 2019.
As mentioned in our May newsletter, there was a Graduate Medical Education issue included in the IPPS proposed rule. After considering comments from the public, CMS has finalized its rule. Below is a summary of the GME related issues in...Read More
July 24, 2019
In general, a provider cannot claim Direct Graduate Medical Education (DGME) FTEs but can claim Indirect Graduate Medical Education (IME) FTEs for training rotations associated with foreign dental graduates (those students graduating from a dental school not located in the US, Canada or Puerto Rico).
If you have spent time working with the Intern & Resident...Read More
June 18, 2019
The Balanced Budget Act of 1997, also known as the 1996 FTE Cap or Base Year FTE Cap, limited the number of residents a teaching hospital can receive for Medicare Graduate Medical Education (GME) reimbursements. This limit was not the only limit implemented with the passing of the Balanced Budget Act of 1997; hospitals were also faced with a requirement to average...Read More