Strengthening Your Financial Strategy Through Smarter Resident Scheduling

Resident scheduling is often considered a day-to-day operational task, but in Graduate Medical Education (GME), it plays a critical financial role. Beyond its importance for accreditation and program management, scheduling directly impacts CMS reimbursement through Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments.

At Germane Solutions, our Finance and Operations teams regularly support institutions in aligning scheduling practices with reimbursement strategy. Here’s why schedule accuracy matters and what your institution should prioritize to ensure full reimbursement.

Resident Schedules Drive Medicare Reimbursement

Each year, teaching hospitals submit Intern and Resident Information System (IRIS) data as part of their Medicare Cost Report. This data is pulled directly from resident and fellow schedules and determines claimable FTEs under DGME and IME.

For new teaching hospitals, accurate scheduling is even more critical: the DGME and IME caps are set based on the training activity in the initial years and are locked in perpetuity. Inaccuracies in early scheduling can permanently limit future reimbursement.

The Cost of Incomplete or Inaccurate Schedules

CMS requires complete, validated schedules for every resident across the entire fiscal year. Gaps or inconsistencies may be treated as non-training time, resulting in lost FTEs and reduced funding.

Common issues include:

• Missing or incomplete rotation blocks

• Incorrect “primary” rotation designations

• Electives at outside institutions not properly flagged as non-reimbursable

• PGY level mismatches with official records

• Overlapping rotations without a clear primary assignment

While preventable, these errors can add up to significant financial loss if not proactively addressed.

Rotation Setup Must Reflect Real-World Training

In addition to accurate schedules, CMS requires that rotations align with actual training locations and provider numbers. Hospitals should regularly verify that:

• Rotations are assigned to the correct CMS provider number

• DGME and IME applicability is clearly defined

• Training time is allocated appropriately across sites

• Rotation settings match where residents are physically training

Even small discrepancies between rotation definitions and real-world practice can undermine IRIS data and delay or reduce reimbursement.

A Strategic Approach to Scheduling

Resident scheduling is not just an administrative task; it’s a foundational component of financial management in GME. Teaching hospitals that prioritize schedule accuracy protect their reimbursement, avoid audit risk, and support the long-term sustainability of their educational programs.

At Germane Solutions, we help institutions build IRIS-ready schedules, optimize reimbursement strategies, and train staff to maintain scheduling data with consistency and accuracy.

If your team is preparing for IRIS submission or looking to strengthen your scheduling workflows, contact us to learn how we can help.