Are We Maximizing the GME Reimbursement for our Programs in the Cap Development Period?

Are We Maximizing the GME Reimbursement for our Programs in the Cap Development Period?

THE CLIENT

Germane was contacted by a large, rural hospital that wanted to ensure their Medicare GME Reimbursement was reported correctly and that all reimbursement that the provider was entitled to be being claimed. The hospital had multiple programs – some in their cap development period and some legacy programs.

THE CHALLENGE

With the recent turnover in the GME Office, the Residency Management Software (RMS) was being under-utilized and resident information was being incorrectly loaded. These “small” issues can lead to significant financial impact by not properly setting the cap during the cap development period. If the GME Office is not well-versed in the CMS regulations for counting residents, eligible time is often not reported, which sets the GME cap(s) at a lower level than it otherwise should.

THE SOLUTION

Germane worked closely with the GME office and program leadership to attain the current resident rotation schedules, an Intern and Resident Information System (IRIS) reports to better understand the nature, duration, and location of each resident rotation. Through this analysis, we identified opportunities to claim additional FTEs that would have been lost. These opportunities have a ripple effect throughout the cap development period that impact future report and ultimately the cap that is set. If these issues were not addressed, the hospital would be stuck with a lower FTE cap in perpetuity, and the program would constantly be facing budgeting issues. The corrections to the cost report and supporting documentation were sent to the hospital's Medicare Administrative Contractor (MAC), and the cost reports were either amended or refiled as needed.

THE GERMANE EFFECT

These seemingly small changes to the reporting of the residents’ time allowed for immediate recapture of “lost” reimbursement. Total adjustment to prior period Medicare Cost Reports provided upwards of a million dollars and untold millions more through higher GME caps.

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