GME/IME

Reimbursement services associated with the Graduate Medical Education / Indirect Medical Education (GME / IME) go far beyond ensuring that the resident count from the affiliated medical school is reported on the cost report. Beginning with legislation in the late 1990's, the regulatory revisions implemented the way that GME / IME residents are reimbursed and recent clarification of policies proposed for future treatment have given rise to certain complexities throughout this area of reimbursement.

Discovery Healthcare Consulting Group has the experience in the reporting, regulatory and audit guidelines, as well as appeals to ensure proper reporting of the resident FTE count allowed and the appropriate documentation needed to support this count and reimbursement during review. With current regulatory developments and the changes recently published to redistribute CAPs by CMS, it is important for hospitals with GME programs to consider:

  • Review of Affiliation Agreements for Compliance with Medicare Regulations
  • Hospital and Medical School affiliations
  • Hospital and Non-provider settings where residents rotate outside of the hospital setting
  • Contracts in support of the reporting for Displaced Residents
  • Reimbursement issues related to residents in newly certified residency programs
  • Processes to prepare the Standardized Rotation Schedules between medical school departments to properly support rotations at your facility
  • Treatment and agreements related to proper reporting of residency Rural Track Programs
  • Calculation of the resident FTE's during initial reporting periods to ensure proper calculation of the three-year rolling average for eligible FTE's
  • New Program strategy and structure for proper ACGME approval and reimbursement of GME and IME

Our comprehensive services range from preparation and consultation services related to the GME / IME reimbursement and cost recovery services in ensuring proper reporting of recently settled cost report issues to assistance with planning and an implementation for start-up programs. We have also provided review services of current and past reporting to ensure compliance with applicable legislation.