March 12, 2025

Top Questions from the Maximize The Accuracy of IME/GME Webinar

Looking for more information about Maximizing the Accuracy of IME/GME? BESLER’s Director of Reimbursement Services Christina Brown answers your questions from the recent webinar.

To watch Christina’s Maximize the Accuracy of IME/GME Webinar, click HERE.

1. 1. 1. What FTE value is inputted on WS S-3 re. I/R FTE values? Is it GME weighted, GME Unweighted or IME values for Acute, Psych & Rehab?
      
      From the PRM: Enter the number of intern and resident FTEs in an approved program, determined in accordance with 42 CFR 412.105(f), for the indirect medical education adjustment. The FTE residents reported by an IPF PPS facility or an IRF PPS facility (whether freestanding or a unit reported on line 16 or 17, respectively, of an IPPS hospital’s cost report) shall be determined in accordance with 42 CFR 412.424(d)(1)(iii) for IPFs, and in accordance with the 70 FR 47929-47930 (August 15, 2005) for IRFs.
    2. Clarification – there are no reopening opportunities related to the Hershey case?
      
      Re-openings have to be approved by your MAC.
    3. How do you get Medicare to accept the program?
      
      Programs must be accredited by the Accreditation Council for Graduate Medical Education (ACGME).
    4. We have had a certified Pharmacy Resident program since 2021, but have not submitted the information for cost report reimbursement. I am not sure where to start.
      
      That is a comprehensive question, so here is a link to the section in the Federal Register: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-413/subpart-F/section-413.85
    5. For new GME programs, what type of reimbursement do hospitals receive prior to Cap and PRA being set by MAC? Do we file E-4 with an estimated cap and PRA? If not, where do we report costs (which Worksheets)?
      
      Reimbursement will flow through the cost report as usual. Yes, you would complete worksheet E-4. Please see PRA instructions for worksheet E-4 as there is specific mention to reporting new programs.
    6. Do other Health Systems have RN Nurse Residency Allied Health programs which are being successfully paid with pass thru?
      
      It is tricky, but yes, we have heard of success with reimbursement.
    7. If you received a few FTEs in an earlier round, should you continue to apply in future rounds for the FTE slots?
      
      Yes.
    8. Regarding prior year res-bed ratio calc – we have hospitals that are involved in GME affiliation agreements that raise their current year allowable FTE’s. When this happens, the PY res-bed ratio calc changes (more favorably). But do you know if the MACs look at GME affiliation adjustments on IME (E, A line 8) or on the GME Worksheet (E-4, ln 4) in determining the PY Res-Bed ratio calculation?
      
      It’s hard to say what they look at during various stages of review. It should be assumed they would look at whatever information is available to them at the time of audit.