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Graduate Medical Education (GME)
Indirect Medical Education (IME)
Section 1886(d)(5)(B) of the Act provides that prospective payment hospitals that have residents in an approved GME program receive an additional payment to reflect the higher indirect operating costs associated with GME. The regulations regarding the calculation of this additional payment, known as the IME adjustment, is located in existing sections 413.75 and 413.83 of the Medicare regulation.
The size of the IME adjustment depends on the hospital’s teaching intensity and total Federal Inpatient PPS Payments. The teaching intensity is measured by the hospital’s number of residents trained per inpatient bed, which is referred to as the resident-to-bed ratio.
HCS’s GME and IME audit approach includes but is not limited to the following review items:
Next Service: Review of Prior Audited Medicare/Medicaid Cost Reports
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Section 1886 (h)(2) of the
Social Security Act sets forth a payment methodology for the
determination of a hospital-specific,
base-period per resident amount (PRA) that is
calculated by dividing a hospital’s allowable
costs of GME for the base period by its number
of residents in the base period. Currently, PPS
hospital’s GME costs are determined by
multiplying its “average per resident amount”
by the weighted number of full-time equivalent
(FTE) residents working in all areas of the
hospital and the hospital’s Medicare share of
total inpatient days.
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