GME Solutions can assist your hospital with all aspects of GME Medicare Reimbursement

Exclusively resolving GME Medicare Reimbursement issues for over 20 years.

Creating a clear path between the School of Medicine and the Hospital Finance Department.

A hospital's Medicare reimbursement for its Graduate Medical Education program is significantly based on the cost reports filed during its first few years of establishing the programs.

The impact of an incorrect settlement has the potential to cost your hospital to lose tens of thousands, upwards to millions of dollars cumulatively.

Who We Are

GME Solutions, LLC is the premier GME/IME Medicare reimbursement consulting firm in the country. Our services have been dedicated exclusively to GME/IME reimbursement issues since 1995 and we have recovered over one hundred and fifty million dollars for our clients.

We have assisted our hospital clients to receive accurate Medicare reimbursement for their GME programs through many avenues, including:

  • IRIS Preparation
  • Original Audit
  • Mediation
  • Reopening Requests
  • PRRB Appeals/ Administrative Resolutions
  • Settlement with U.S. Attorney
  • Success in the 7th Circuit Court of Appeals
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From IRIS Filings To Audits, Re-openings & Appeals

GME Solutions has extensive experience dealing with several MACs across the nation, the PRRB, and CMS. By engaging our Firm, you are acquiring our knowledge of Medicare rules as applied to accreditation and certification requirements for medial residents. We serve as your agent when you subcontract this extremely specialized process to us.

$+ Million
Recovered for our clients, Over the last 20 years

Teaching Hospitals

Serviced over 40 top tier teaching hospitals

Ongoing Evaluation

Measurable success based on proficiency of Government Policy Development and extensive ongoing evaluation and understanding of procedures

Recovery

GME Solutions typically recovers $50,000 – $150,000 per year for our hospital clients minimizing DGME penalty impact.

GME Cap Penalty

In addition to the FTE cap and weighting of residents outside their initial residency period, hospitals are penalized for training residents outside their initial residency while over the cap. To minimize this penalty it is imperative to a hospital to have reported the weighted FTE counts accurately. We can assist in the review of the weighted FTE count. Inaccurate weighted counts can reduce the amount of reimbursement. This type of review results in a $125,000 increase in reimbursement, on average.

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New Teaching Programs

Establishing Graduate Medical Education programs includes navigating through large amounts of data, documentation, and complex regulations. GME Solutions can work with your team on providing Medicare Reimbursement projections for establishing Graduate Medical Education residency programs, while keeping your hospital’s Medicare reimbursement needs as our primary objective.

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Non-Approved Teaching Programs

Major academic medical centers training residents in unaccredited ACGME/AOA programs may be eligible to receive reimbursement for these residents. We prepare the documentation and necessary reports with the MAC to negotiate final settlement. Although the payment method differs from the GME and IME payment methodology, we have successfully recovered $15,000 - $25,000 per eligible resident enrolled in Medicare non-approved teaching programs.

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Educational Seminars

Rotation schedules are important to both the Graduate Medical Education (GME) departments as well as the Finance Department. However, the uses for the rotation schedules in each department could not be more different. GME Solutions provides educational seminars for the Graduate Medical Education departments in order to give details on what information the Finance Department needs to have included in rotation schedules to ensure proper Medicare reimbursement.

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Compliance Review

It is becoming increasingly difficult to successfully appeal or reopen cost reports. This puts pressure on providers to file correctly the first time.

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