What is GME and what does it Have to do with my Cost Report?

GME stands for “Graduate Medical Education”.  After a student has finished his/her medical training, he/she still needs to undergo more education to become fully certified as a doctor.  These students are typically known as “Residents”.

 The federal government has recognized that your RHC/ FQHC is an excellent place for these residents to train, and that such training incurs costs on part of your facility.  Congress has recognized that such costs “should be borne to an appropriate extent by the hospital insurance program” (House Report, Number 213, 89th Congress, 1st session 32 (1965) and Senate Report, Number 404 Pt. 1 89th Congress 1 Session 36 (1965)).  As such, Medicare will now reimburse your facility for some of those costs, with a cap of $500,000 and three years of training.

According to the Medicare Benefit Policy Manual on the CMS website (www.cms.gov):

RHCs and FQHCs may receive direct graduate medical education (GME) payment for residents if the RHC or FQHC incurs all or substantially all of the costs for the training program. “All or substantially all” means the residents’ salaries and fringe benefits (including travel and lodging expenses where applicable), and the portion of teaching physicians’ salaries and fringe benefits attributable to direct graduate medical education.

What this means for your facility is that you should look into establishing such a residency program.  You may thus qualify for grants and other payments directly from Medicare.  With all of the health care reform, this is an opportunity for reimbursement that you may wish to explore!

What this means for your cost report is that there are several new lines and modified calculations:

  • Worksheet A now includes line 20.50 – Allowable GME Pass Through Costs, which you now have to enter
  • Worksheet A also includes line 50.30 – Non-allowable GME Pass Through Costs, which you now have to enter
  • Worksheet B, Part II, Line 14.01 will calculate GME Overhead, which is separated out from the cost of RHC/ FQHC services calculated in lines 10 and 15
  • Worksheet C, Part I now includes line 15.10 – GME Pass Through Cost, with Line 16 adding those costs to the Total Medicare Costs

Of course, your new RHC/ FQHC software has been modified to comply with all of the new regulations and calculations.

For your convenience, PPS offers:

Feel free to contact us: info@ppsassistant.com

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