Some Hospitals in Florida and Puerto Rico Claimed Residents as More than One Full-Time Equivalent .

摘要

Federal law authorizes two types of payments to teaching hospitals to support GME programs for physicians and other practitioners. Direct GME payments are Medicares share of the direct costs of training residents, such as salaries and fringe benefits of residents and faculty and hospital overhead expenses. Indirect GME payments cover the additional operating costs that teaching hospitals incur in treating inpatients, such as the costs associated with using more intensive treatments, treating sicker patients, using a costlier staff mix, and ordering more tests. A hospital claims reimbursement for both direct and indirect GME, in part, based on the number of FTE residents that the hospital trains and the portion of time those residents spend working at the hospital. No resident may be counted as more than one FTE. The Centers for Medicare & Medicaid Services (CMS) makes available the Intern and Resident Information System (IRIS), a software application that hospitals use to collect and report information on residents working in approved residency training programs at teaching hospitals. The primary purpose of the IRIS is to ensure that no resident is counted by the Medicare program as more than one FTE employee in the calculation of payments for the costs of direct and indirect GME. First Coast Service Options, Inc. (First Coast), is a MAC under contract with CMS to administer the Medicare Part A (hospital insurance) program for Jurisdiction 9. For fiscal years (FYs) 2009 and 2010, hospitals in MAC Jurisdiction 9 claimed GME reimbursement totaling approximately $155 million for direct GME and $330 million for indirect GME. Florida.