Reintroduction of the Resident Physician Shortage Reduction Act of 2019
March 13, 2019 On February 5, 2019, Senator Minority Leader Chuck Schumer (D-NY), Senator Bob Menendez (D-NJ), and Senator John Boozman (R-AR) introduced the Resident Physician Shortage Reduction Act of 2019. This bill is similar to the ones introduced in 2013 and 2017. Both previous bills were unsuccessful, however, with the growing need for doctors to service the aging population,...Read More
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NRMP Match Day: Significance to Medicare Reimbursement
February 20, 2019 On March 15th, fourth-year medical students across the nation will gather for NRMP Match ceremonies — a life-changing day for medical students and an important day in determining accurate Medicare Direct Graduate Medical Education (DGME) payments. Residency program staff and GME offices have been equally preparing for this day and their work will continue after...Read More
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CMS Announces MLN Event to Discuss New Electronic System for PRRB Appeals
January 29, 2019 The Centers for Medicare & Medicaid Services (CMS) will be holding a Medicare Learning Network (MLN) event specifically for Part A providers, Medicare contractors, and other PRRB stakeholders to discuss the benefits of using the Office of Hearings Case and Document Management System (OH CDMS). The call is scheduled for Tuesday, February 5th from 1:30 – 3:00...Read More
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Breaking Down the GME Payment: Per Resident Amount
Januray 16, 2019 When Medicare was established, Congress assigned the government responsibility of covering partial costs affiliated with reimbursing teaching hospitals for residents in approved Graduate Medical Education Programs since these educational activities enhanced the quality of patient care.1 One important factor in the Direct Graduate Medical Education (DGME) payment is the...Read More
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Claiming Resident Time in Inpatient Psychiatry & Rehabilitation Facilities
December 11, 2018 If residents are enrolled in a Medicare-approved program and rotate into the Inpatient Psychiatry Facility (IPF) or the Inpatient Rehabilitation Facility (IRF), they cannot be claimed for Indirect Graduate Medical Education (IME) on the Intern and Resident Information System (IRIS) report. However, they may be counted and included in a separate Medicare cost report...Read More
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Increasing Audits of GME Hospitals
November 14, 2018 The Office of Inspector General (OIG) issued a report titled “CMS Did Not Always Ensure Hospitals Complied With Medicare Reimbursement Requirements For Graduate Medical Education”. Said report was based on OIG audits, which found that hospitals in six Medicare Administrative Contractors (MAC) jurisdictions counted residents (including interns) as more than one full-time...Read More
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Incorrect FTE Reporting Could Penalize Your Hospital
October 16, 2018 September’s newsletter provided a breakdown of the Intern and Resident Information System (IRIS) report. This newsletter will focus on one of the most important stats in the IRIS Report — the initial residency program. The initial residency program is important because it generates the initial residency period, which we will refer to as the “IRP”. Since most hospitals are...Read More
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IRIS Reporting Breakdown
September 19, 2018: Academic medical centers are required to submit to Medicare their Intern and Resident Information System (IRIS) report with their yearly cost report filing. The IRIS report is used to calculate the amount of reimbursement the hospital will receive for the direct and indirect costs of the Graduate Medical Education programs. The IRIS report contains information regarding...Read More
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FY 2019 IPPS Final Rule
August 14, 2018: CMS has made available its display version of the FY 2019 IPPS Final Rule, which is scheduled to be published on August 17, 2018. As mentioned in our May newsletter, there were Graduate Medical Education issues included in the IPPS proposed rule. After considering comments from the public, CMS has revised its proposed rule. Below is a summary of the GME related issues in the...Read More
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Good News for GME Reimbursements — Saint Francis Medical Center v. Azar Decision
August 1, 2018: On June 29, 2018, in the D.C. Circuit Court of Appeals, a significant victory in a Medicare reimbursement appeal was obtained. This case involved 277 hospitals seeking to challenge various payment decisions spanning the last two decades. The providers were contesting so-called “predicated facts” (factual determinations relevant to the payment year at issue, but were made in...Read More
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