CMS has been busy addressing GME and IME issues in recent days. First, in late April, the agency issued its proposed Federal Fiscal Year 2013 inpatient prospective payment system (IPPS) update, which contains a number of proposed revisions regarding the GME and IME payment provisions. Second, at the very end of April, it issued guidance regarding applications for additional FTE slots under § 5506 of the Affordable Care Act (ACA).

The FY 2013 IPPS Proposed Rule

1. In the proposed rule, CMS "clarifies" its policy regarding claiming IME and GME payment for services provided to Medicare Advantage (MA) enrollees. Those payments have been permitted since 1998, and CMS has maintained in litigation that hospitals were required to submit Medicare claims to their Medicare contractors for the MA (previously, M+C) enrollees in UB-92 format in order for days associated with those enrollees to be counted. In the IPPS update, CMS repeats this position, stating that it was "always our intent that the time limits applicable in 42 U.S.C. § 424.44 apply to those claims submissions." Similarly, says CMS, the timely filing limits of § 424.44 apply to claims related to nursing and allied health education program payments for services provided to MA enrollees.