Medicare GME / IME Services

Teaching hospitals rely heavily on Medicare reimbursement for Indirect Medical Education (IME) and Graduate Medical Education (GME). Over the years, Medicare regulations have evolved to make expert understanding necessary for optimal reimbursement. It’s not only a matter of knowing today's regulations- you have to know yesterday's regulations as well.

The IME/GME payment provisions are among the most complicated in Medicare reimbursement. If you're not an expert in this complex history and regulatory evolution, you may be losing hundreds of thousands to millions of dollars.

This complex regulation has a number of critical components that may have different requirements for different cost reporting years. To maximize your IME/GME reimbursement and ensure compliance, you need to carefully scrutinize the rules for:

Residents working in non-hospital settings
Intern time spent in non-approved programs
Time spent in administrative or didactic activities
The three year rolling average for allowable FTE's
Resident research time not spent in the treatment or diagnosis of a particular patient
Bed size analysis
Counting intern/resident time in psych and rehab units

The consultants at Toyon Associates have decades of experience assisting teaching hospitals with IME/GME reimbursement issues.