Latest News | GME/IME

Medicare GME – Final Section 5506 Cap Increase List Released

From: CMS Inpatient Acute Website – 2/28/12

CMS posted the GME/IME redistribution listing on their website earlier this week.  There is a download file that contains the hospitals by provider receiving increases in the GME/IME FTE caps.  A summary of the winning States and total redistributed FTEs is presented below:

From: CMS Transmittal 1017 (Pub 100-20) – 1/24/12

Summary of Changes

This transmittal replaces Transmittal 1014 dated January 6, 2012 to correct  the effective date of the implementation of this ruling.  The corrected effective date is January 30, 2012.  The transmittal involves instructions to contractors to inform teaching hospitals of the proper way to report the FICA refund for medical residents on the Medicare cost report.

Medicare GME/IME – Alegant Health Immanuel Med Ctr

PRRB 2012-D7 – January 20, 2012 (FYE 6/30/00 – 6/30/03)

There are two DGME/IME issues in this case:

1. Whether the Hospital had properly established an affiliation agreement with another Hospital for 10 resident FTEs that were disallowed by the Intermediary.
2. Whether there the claimed New Psychiatric Residency program met the new program requirements.

The PRRB ruled in favor of the Hospital in issue one and against the Hospital in issue two. 

MLN Matters Article MM7685 Revised – 1/06/12

MLN Summary:

This article is based on Change Request (CR) 7685 which informs teaching hospitals and Medicare contractors of the proper way of reporting Internal Revenue Service (IRS) Refunds of Medicare FICA taxes on cost reports. Teaching hospitals must work with their Medicare contractor to make any necessary changes by January 30, 2012, to their Fiscal Year (FY) 2009 cost reports to be used in the FY2013 wage index. See the Background Section for further details regarding this requirement.

Medicare GME/IME – Oakwood Annapolis Hospital

PRRB 2012-D4 – December 30, 2011 (FYE 12/31/04 – 12/31/06)

The dispute in this appeal is whether the Hospital met the definition of a “new” residency program in 2004.  The facts in this case were fairly complicated and should be read in the case if you have a similar type of case.  The PRRB ruled in favor of the Hospital and that it was under the current rules and regulations considered a “new” residency program.

Medicare IME/GME – Sutter 98-99 Managed Care Group

CMS Admin Decision: PRRB 2011-D34

The CMS Administrator overturned the 6/16/2011 PRRB (2011-D34) decision allowing the DGME/IME payments related to managed care days, discharges, and simulated payments solely on the grounds the provider failed to submit UB92 claim forms related to Medicare managed care beneficiaries.

DGME/IME & DSH SSI% Issues – FI Reopening of Multiple Cost Report Years

PRRB- 2011-D46 – September 27, 2011

This appeal involved two issues:

1. Adjustment to DGME/IME FTEs through a reopening of several years. The issue for the reopening and disallowance of I&R FTEs was that the hospital did not incur all or substantially all of the cost of training for rotations in non-provider sites. The PRRB, after consideration of the considerable facts, determined that the FI improperly excluded time spent training at non-hospital sites. They determined that the providers did meet the statutory and regulatory requirements for inclusion and reversed the FI’s adjustments.
    
2. The second issue involves a dispute of the DSH/SSI percentage determination. The PRRB remanded this issue to CMS for recalculation under the terms of CMS Ruling CMS-1498-R.

Teaching Physician Services

Transmittal 2303 – September 14, 2011

Summary of Changes:

 Effective January 1, 2011, section 4103 of the Affordable Care Act provided coverage for annual wellness visits (HCPCS codes G0438 and G0439). These codes are included under the primary care exception. The policies concerning late night admissions and the mix of residents under the primary care exception have been clarified. The policies concerning the interpretation of diagnostic radiology and other diagnostic tests and the use of the GC and GE modifiers, which were inadvertently omitted during previous manual updates, are included in this CR. This CR instructs contractors to recognize and implement manual updates.

CMS Releases Distribution of Additional Residency Positions

CMS E-mail release: August 16, 2011

CMS released the list of all hospitals impacted by the GME/IME FTE redistribution that was initiated by ACA.  There is a spreadsheet by provider that includes all hospitals losing and gaining GME/IME FTEs.  Total redistribution from this process: IME: 628; GME 726 FTEs. 

Text of CMS E-mail:

On August 15, 2011, CMS released the results of its decisions regarding which teaching hospitals are receiving reductions and/or increases to their direct GME and IME FTE resident caps.  Section 5503 of the Affordable Care Act provides for reductions in the direct GME and IME FTE resident caps for certain hospitals, and authorizes a “redistribution” to certain hospitals of the estimated number of FTE resident slots resulting from the reductions. Effective for portions of cost reporting periods occurring on or after July 1, 2011 for direct GME and IME, a hospital’s FTE resident caps will be reduced by 65 percent of the “excess” resident slots. The Secretary is also authorized to increase the otherwise applicable FTE resident caps for each qualifying hospital that submits a timely application by a number that the Secretary may approve, effective for portions of cost reporting periods occurring on or after July 1, 2011. Hospitals’ requests for FTE resident cap increases were limited to no more than 75 FTE positions for direct GME and IME, respectively. Section 5503 specifies that the slots are to be distributed in the following manner: 70 percent of the resident slots are to be distributed to hospitals located in States with resident-to-population ratios in the lowest quartile, and 30 percent of the resident slots are to be distributed to hospitals located in a State, a territory of the United States, or the District of Columbia that are among the top 10 States, territories, or Districts in terms of the ratio of Health Professional Shortage Area (HPSA) population to the total population, and/or to hospitals located in rural areas of any State. Hospitals not located in these states or in a rural area do not qualify for redistributed slots. To see the list of hospitals receiving FTE resident cap decreases or increases or both, click on the link below and scroll down until you find the file called “Section 5503 Cap Decreases and Increases”.

AAMC Site – July 7, 2011

The Association of American Medical Colleges (AAMC) is pushing back hard against debt-ceiling proposals to cut Medicare spending on graduate medical education.

Excerpt from Site:

America has the world’s best doctors and nurses because we have the best teaching hospitals. However, cuts to graduate medical education (GME) would jeopardize the ability of medical schools and teaching hospitals to train physicians, nurses, and other health care providers, as well as limit critical services to the community.  Cutting the deficit is important, but cutting physician training at a time when our nation faces a critical shortage of doctors would threaten the health of all Americans.

AAMC – Open Letter to President Obama (GME/IME Funding Cuts)