Graduate Medical Education programs that are not approved for Medicare GME and IME payments may be eligible for payments based on reasonable cost principals. Although the payment method differs from the GME and IME payment methodology, we have successfully recovered $15,000 – $25,000 per resident for non-approved teaching programs.
The type of programs that may be eligible for the Medicare nonapproved payment are those that are not accredited by the ACGME, and the training in the program does not lead to board certification for the resident. Additionally, program years that exceed the accreditation length may also be eligible for the Medicare nonapproved payment.
Due to strict appeal rules and jurisdictional challenges when appealing issues, we recommend the hospital include the nonapproved program costs in their cost report filing. We prepare the documentation and necessary reports and work with the MAC during the audit to finalize reimbursement for the nonapproved programs. If there are cost reporting years that are still within the three-year reopening window, we also prepare the documentation for a reopening request. We then work with the MAC to negotiate settlement.
We can conduct this review on a contingency fee basis, therefore, there is no upfront costs to your hospital.