Breaking Down the GME Payment: Medicare Utilization
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
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Do Leave of Absences Impact Medicare GME Reimbursements?
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
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Electives – A Common Adjustment in Medicare Audits
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
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The Life of a Medicare Cost Report
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. Cost...Read More
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FY 2020 IPPS Final Rule
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
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Claiming Foreign Dental Graduates on the IRIS Report
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
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Balanced Budget Act of 1997: Rolling Average Explained
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
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CMS Releases Proposed 2020 IPPS Rules – Impact to Graduate Medical Education
May 8, 2019 The Centers for Medicare and Medicaid Services (CMS) published the proposed changes to the Inpatient Prospective Payment System (IPPS) rules for fiscal year 2020 on May 3, 2019. The proposed rules addressed multiple issues, two of which impact Graduate Medical Education: Modifications to Nonprovider Settings — If finalized, the rule will allow hospitals to count...Read More
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Hope for Hospitals that Inadvertently Triggered GME Caps: Advancing Medical Resident Training in Community Hospitals Act
April 16, 2019 Two US Members of the House of Representatives from Wisconsin reintroduced a bipartisan bill titled Advancing Medical Resident Training in Community Hospital Act on February 26, 2019 (H.R. 1358). The bill introduced by Representatives Ron Kind (D-WI) and Mike Gallagher (R-WI) provides relief for Community hospitals that inadvertently established low permanent full-time...Read More
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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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