What is IME and GME?
Teaching hospitals receive a payment from Medicare for Indirect Medical Education (IME) and Graduate Medical Education (GME) expenses. This payment helps to defray the added costs of maintaining teaching programs.
How is Medicare DRG reimbursement calculated?
The MS-DRG payment for a Medicare patient is determined by multiplying the relative weight for the MS-DRG by the hospital’s blended rate: MS-DRG PAYMENT = RELATIVE WEIGHT × HOSPITAL RATE.
How is GME calculated?
Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and non-hospital sites, when applicable), and the hospital’s Medicare share of total inpatient days.
How Does Medicare pay IME?
Medicare reimburses teaching hospitals for the costs of GME on a cost per resident basis. Indirect medical education (IME) costs, on the other hand, are additional patient care costs associated with the training of interns and residents.
What are GME payments?
Medicare GME payments cover Medicare’s share of the costs of a hospital’s approved medical residency program. These costs include direct costs of operating a residency program, such as resident stipends, supervisory physician salaries, and administrative costs.
What is a Medicare IME?
The indirect medical education (IME) and disproportionate share hospital (DSH) adjustments to Medicare’s prospective payment rates for inpatient services are generally intended to compensate hospitals for patient care costs related to teaching activities and care of low income populations.
What is ime in medical billing?
What Is an Independent Medical Exam? An IME is defined as “the evaluation of an injured party that utilizes a third party, independent medical professional to issue an unbiased opinion on the injury.”
What is DRG base rate?
To figure out how much money your hospital got paid for your hospitalization, you must multiply your DRG’s relative weight by your hospital’s base payment rate. Here’s an example with a hospital that has a base payment rate of $6,000 when your DRG’s relative weight is 1.3: $6,000 X 1.3 = $7,800.
What is Medicare DRG reimbursement?
Diagnosis-Related Group Reimbursement. Diagnosis-related group reimbursement (DRG) is a reimbursement system for inpatient charges from facilities. This system assigns payment levels to each DRG based on the average cost of treating all TRICARE beneficiaries in a given DRG.
How Does Medicare pay GME?
Notes: Medicare’s payments for GME are based, in part, on the number of full-time equivalent residents that a hospital trains. Caps reflect the number of residents eligible for the two GME payment types.
How does GME funding work?
Direct GME payments are based on current costs and are paid either through a disbursement agreement with the sponsoring organization or directly to residents. Accredited residency and fellowship years are fully funded.