June 3, 2020
CMS has published the FY 2021 Inpatient Prospective Payment Services (IPPS) Proposed Rule on May 29th. In the FY 2021 IPPS proposed rule, CMS addresses changes to closing hospitals and Graduate Medical Education (GME) residency programs that could take effect as soon as October 1, 2020. The proposed rule addresses growing concerns of operational and administrative...Read More
May 11, 2020
On April 30, 2020, The Center for Medicare & Medicaid Services (CMS) released a new set of waivers aimed at relieving financial pressure on Graduate Medical Education (GME) programs to address the needs of the COVID-19 pandemic.
Following is a summary of waivers directly related to GME Programs:
Temporary Bed Increase Will Not Impact IME Payments
For the...Read More
April 20, 2020
In an April 7th letter to Congress, U.S. Representatives Josh Gottheimer (NJ-5) and Bill Pascrell, Jr. (NJ-9) have requested an increase in Graduate Medical Education (GME) slots for hospitals to be included in the next COVID-19 legislative package.
“This would help alleviate the staffing burden that has plagued so many hospitals across the country, and...Read More
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
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
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
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
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
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