42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs
| Cite as | 42 CFR 412.105 |
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110 practice notes
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program
...teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment are located at 42 CFR 412.105. The hospital's IME adjustment applied to the DRG payments is calculated based on the ratio of the hospital's number of FTE residents trai......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program
...teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment are located at 42 CFR 412.105. The hospital's IME adjustment applied to the DRG payments is calculated based on the ratio of the hospital's number of FTE residents trai......
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California Seniors v. Catholic Healthcare, No. B140639.
...receive additional payments through indirect medical education adjustments for inpatient operating and capital-related costs. (42 C.F.R. § 412.105; Fundamentals, supra, p. 48.) For each claim submitted, a notice of program reimbursement (NPR) is issued to the provider to explain the provide......
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SWEDISH AMERICAN HOSPITAL v. Sebelius, Civil Action No.: 08-2046 (RMU).
...The Secretary subsequently revised the regulations concerning the GME and IME resident caps in 1998, 1999 and 2001. See 42 C.F.R. §§ 413.86, 412.105 (1998); 42 C.F.R. §§ 413.86(g)(8)(1999); 42 C.F.R. §§ 413.86(g)(8)(iii), 412.105(f)(1)(ix) B. Factual and Procedural History The plaintiff is ......
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46 cases
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684 F.Supp.2d 42 (D.D.C. 2010), C. A. 08-01520(HHK), Loma Linda University Medical Center v. Sebelius
...359) (internal quotation marks omitted). Reimbursements for IME costs are calculated based on the ratio of residents to hospital beds. 42 C.F.R. § 412.105; AR Before Congress passed BBA '97, hospitals received reimbursement from the Secretary for DGME and IME costs associated only with serv......
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670 F.Supp.2d 148 (D.R.I. 2009), Civ. A. 06-05 S, Rhode Island Hosp. v. Sebelius
...reference to the hours residents work. Only qualified activities under Medicare regulations count towards a hospital's FTE tally. See 42 C.F.R. § 412.105(f) (2009) (establishing rules for determining the number of B. Procedural History For fiscal year 1996, Plaintiff sought IME payments for......
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670 F.Supp.2d 148 (D.R.I. 2009), Civ. A. 06-05 S, Rhode Island Hosp. v. Sebelius
...reference to the hours residents work. Only qualified activities under Medicare regulations count towards a hospital's FTE tally. See 42 C.F.R. § 412.105(f) (2009) (establishing rules for determining the number of B. Procedural History For fiscal year 1996, Plaintiff sought IME payments for......
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Rhode Island Hosp. v. Sebelius, 112509 RIDC, 06-05 S
...reference to the hours residents work. Only qualified activities under Medicare regulations count towards a hospital’s FTE tally. See 42 C.F.R. § 412.105(f) (2009) (establishing rules for determining the number of B. Procedural History For fiscal year 1996, Plaintiff sought IME payments for......
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13 firm's commentaries
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CMS Interim Rule Makes Sweeping Changes in Response to COVID-19 Public Health Emergency
...of an excepted PBD and bills OPPS using the appropriate modifier. Section G. Medical Education CMS is revising regulations at 42 CFR § 412.105(d)(1) to ensure that teaching hospitals do not experience a reduction in indirect medical education (IME) payments resulting from a temporary surge ......
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CMS Interim Rule Makes Sweeping Changes in Response to COVID-19 Public Health Emergency
...of an excepted PBD and bills OPPS using the appropriate modifier. Section G. Medical Education CMS is revising regulations at 42 CFR § 412.105(d)(1) to ensure that teaching hospitals do not experience a reduction in indirect medical education (IME) payments resulting from a temporary surge ......
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Payment Matters: Hospitals Suffer Setback in IME Research Case
...Cir. Aug. 18, 2011) [PDF] The single issue in the district court cases and in the Rhode Island case was how to read the regulation at 42 C.F.R. § 412.105(f), which specifies that a resident’s time may be included in the IME FTE count if the resident is (1) enrolled in an approved teaching p......
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CMS Proposed Rule Includes Significant Changes to Medicare GME Funding
...in which they are enrolled. The Medicare direct GME regulations (42 CFR 413.79(h)) and indirect medical education (IME) regulations (42 CFR 412.105(f)(1)(ix)) enable a hospital that is closing, or that may close one or more of its GME programs (commonly referred to as the “originating hospi......
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51 provisions
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Hospitals and Certain Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program
...teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment are located at 42 CFR 412.105. The hospital's IME adjustment applied to the DRG payments is calculated based on the ratio of the hospital's number of FTE residents trai......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2015 Rates; Quality Reporting Requirements for Specific Providers; Reasonable Compensation Equivalents for Physician Services in Excluded Teaching Hospitals; Provider Administrative Appeals and Judicial Review; Enforcement Provisions for Organ Transplant Centers; and Electronic Health Record (EHR) Incentive Program
...teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment are located at 42 CFR 412.105. The hospital's IME adjustment applied to the DRG payments is calculated based on the ratio of the hospital's number of FTE residents trai......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions of Participation; Payment Policies Related to Patient Status
...days associated with beds in excluded distinct part hospital units are explicitly excluded from the DPP calculation in accordance with 42 CFR 412.105(a)(1)(ii)(A). In contrast, the days for MA beneficiaries that are counted in the Medicare/SSI fraction are days on which those beneficiaries ......
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Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident Caps for Graduate Medical Education Payment Purposes; Quality Reporting Requirements for Specific Providers and for Ambulatory Surgical Centers
...teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment are located at 42 CFR 412.105. The hospital's IME adjustment applied to the DRG payments is calculated based on the ratio of the hospital's number of FTE residents trai......
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