Hospitals that are over their FTE cap and train residents outside their Initial Residency Period (“IRP”) are being penalized in their DGME Medicare Reimbursements.
To ensure that the impact of this penalty is as minimal as possible, GME Solutions offers a Penalty Review. This is a review only of residents who are outside their initial residency period. We conduct this review on a contingency fee basis, therefore, there is no upfront costs to your hospital.
GME Solutions is also creating a group appeal to challenge the implementation of Medicare Statute 42 § U.S.C. 1395ww(h)(4)(F) in an attempt eliminate this penalty. Please contact us for a free impact analysis of your hospital’s penalty resulting from the application of the DGME FTE cap.
It is commonly known that residents training beyond their initial residency period count for half as many FTEs as residents training within their initial residency period. It is also commonly known that the total amount of FTEs that a provider can receive for direct GME reimbursement is limited by an FTE cap. What is not commonly known is that providers who have a greater number of FTEs than their cap allows are penalized for training residents beyond their initial residency period in addition to those residents counting for half FTEs and in addition to the overall FTE cap. To illustrate, let’s compare three hospitals that have identical FTE Caps and Weighted DGME FTE counts. The only difference is the number or residents training outside the IRP. For simplicity, we will call residents inside their IRP “residents” and residents outside their IRP “fellows”