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Medicare Compliance & Reimbursement

HOSPITALS:

Payments Are Iffy For Residents In Nonhospital Settings

Published on Sun Dec 19, 2004

Here's which reimbursement rules are still up for consideration. 

Good news, hospitals: The HHS Office of Inspector General has voted to extend a 2004 moratorium that allows medical education payments for physician supervision of certain residents.

If CMS agrees, fiscal intermediaries will pay even when a teaching hospital does not incur the costs related to physician supervision of osteopathic and allopathic family practice residents.

But it's not a long-term fix. In a final report, "Alternative Medicare Payment Methodologies for the Costs of Training Medical Residents in Nonhospital Settings" (A-02-04-01012), the OIG outlines five alternative methodologies for paying training costs.
 
Facilities may be looking at one of these possible payment rules in the near future:

 

  • current regulations would remain unchanged, but would contain a clarified definition of direct teaching costs, including volunteer time;
      
     
  • in addition to paying the resident's fringe benefits (travel and lodging), each hospital would be required to pay the nonhospital a pre-determined percentage of its per resident amount as a proxy for the nonhospital's teaching and overhead costs;

     

  • 'training costs' would be redefined as the residents' salaries and fringe benefits as determined by each hospital and nonhospital; or

     

  • CMS would directly pay nonhospitals - or supervising physicians - instead of teaching hospitals.
     
    "In the interim we recommend that CMS work with Congress to extend the moratorium, so that teaching hospitals may claim Medicare reimbursement for osteopathic and allopathic family practice residents ... without regard to the financial arrangements between the hospitals and the supervisory physicians who practice at those settings," the OIG said.

    To read the report, go to     www.oig.hhs.gov/oas/reports/region2/20401012.pdf.
     
    Lesson Learned: Hospitals need to stay alert for approaching changes to billing rules.

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