Graduate Medical Education CHGME Payment Program 2009 Workshop IRIS & IRIS Proxy Children’s Hospitals Graduate Medical Education Payment Program IRIS & IRIS Proxy 1

Agenda IRIS IRIS Proxy Updates IRIS Common Errors CHGME Payment Program 2009 Workshop Agenda IRIS IRIS Proxy Updates IRIS Common Errors IRIS EDV3 Edit Program Q & A Session IRIS & IRIS Proxy 2

Intern and Resident Information System CHGME Payment Program 2009 Workshop IRIS Intern and Resident Information System IRIS & IRIS Proxy 3

IRIS Recap Who can use the IRIS? DOS based program (CMS) CHGME Payment Program 2009 Workshop IRIS Recap Who can use the IRIS? Full Filing Providers DOS based program (CMS) Does NOT compute the FTE count of interns/residents IRIS & IRIS Proxy 4

IRIS Files Master File (M3XXXXXX.dbf) Assignment File (A3XXXXXX.dbf) CHGME Payment Program 2009 Workshop IRIS Files Master File (M3XXXXXX.dbf) Contains pertinent information about the interns/residents Assignment File (A3XXXXXX.dbf) Contains the rotational assignment data for those interns/residents Some text fields report Numbers. Microsoft Excel XP will try to identify this as an error. IRIS & IRIS Proxy 5

Refer to Table of Residency Codes (page 7-17). CHGME Payment Program 2009 Workshop IRIS V3 Updates Residency Code Table in Alphabetic Sequence Operating Instructions New Part II, Section 7.4 Part V Revised Part II, Section 7.2 Part II, Section 7.3 Part II, Section 7.5 Refer to Table of Residency Codes (page 7-17). IRIS & IRIS Proxy 6

IRIS V3 Clarifications Employer’s Name CHGME Payment Program 2009 Workshop IRIS V3 Clarifications Employer’s Name Add additional name to the Employer Name Table Add, Modify, or Delete <5> Reference Files/Data Management <2> IRIS Reference Data Management Menu IRIS & IRIS Proxy 7

IRIS V3 Clarifications Residency Years Completed Medical School Code CHGME Payment Program 2009 Workshop IRIS V3 Clarifications Residency Years Completed Range for Total Number of Program Years Medical School Code “99998” – Foreign Dental School “99999” – Foreign Medical School Dental School Codes 10000 & 20000 – Obsolete Use New Codes 80002-80109 IRIS & IRIS Proxy 8

IRIS V3 Clarifications Assignment Time Periods CHGME Payment Program 2009 Workshop IRIS V3 Clarifications Assignment Time Periods Added Non-Hospital Reference 42 CFR 413.78(e) Periods that Span July 1 Enter as 2 periods on IRIS Example Fiscal Year : 10/01/04 – 09/30/05 Rotation: 05/01/05 – 11/30/05 Report Assignments: 05/01/05 - 06/30/05 07/01/05 - 09/30/05 IRIS & IRIS Proxy 9

IRIS V3 Updates – Effective Dates CHGME Payment Program 2009 Workshop IRIS V3 Updates – Effective Dates New Dental School Codes For cost reporting periods BEGINNING on or after July 1, 2006 AND Interns & Residents (I&Rs) in dental specialties with dental school Graduation Dates after April 30, 2006 New Residency Type Codes Highlighted in YELLOW IRIS & IRIS Proxy 10

IRIS V3 Reminders Assignment File Percentages (GME/IME %, Part/Full time Percent Use Whole Numbers Social Security Numbers Links the Assignment file to the Master file CMS Assistance http://www.cms.hhs.gov/IRIS Iris@cms.hhs.gov

Certification of IRIS Diskette CHGME Payment Program 2009 Workshop Certification of IRIS Diskette Since the IRIS report is submitted with the MCR, the signature on the MCR is all that is needed (W/S S, Part I). All rotation schedules or additional certification is not necessary for IRIS verification. IRIS & IRIS Proxy 12

CHGME Payment Program 2009 Workshop IRIS PROXY IRIS & IRIS Proxy 13

IRIS Proxy Recap Who can use the IRIS Proxy? Excel program CHGME Payment Program 2009 Workshop IRIS Proxy Recap Who can use the IRIS Proxy? No/Low Utilization Providers who are not required by CMS to submit an IRIS with their Medicare Cost Report Excel program Computes the FTE resident count Available at no charge to hospitals IRIS & IRIS Proxy 14

CHGME Payment Program 2009 Workshop IRIS Proxy Calculates Total GME Unweighted and Weighted Resident FTE counts by: Each Intern/Resident Rotation Current Specialty Summary Totals Total Allopathic and Osteopathic Residents Total Allopathic and Osteopathic in Initial Residency Period Total Dental and Podiatric Residents Total Dental and Podiatric Residents in Initial Residency Period Option to create IRIS Master and Assignment data files IRIS & IRIS Proxy 15

IRIS Proxy – Summary Totals CHGME Payment Program 2009 Workshop IRIS Proxy – Summary Totals Summary Totals Located in upper right corner of the worksheet   Total FTEs Unweighted Weighted SUMMARY TOTALS: Total Allopathic & Osteopathic Residents 0.2179 0.1718 Total Dental & Podiatric Residents 0.4180 Summary Totals do NOT account for any duplicate assignment periods (overlaps). IRIS & IRIS Proxy 16

IRIS Proxy – Summary Totals Report CHGME Payment Program 2009 Workshop IRIS Proxy – Summary Totals Report Update: Summary Totals Report Totals Report identifies Unweighted and Weighted resident FTE summary by specialty. After viewing Totals Report, click “CHGME” tab at the bottom of the screen to return to original listing. Totals Report FTE Count = Allopathic/Osteopathic FTEs + Dental/Podiatric FTEs IRIS & IRIS Proxy 17

IRIS Proxy – Edits IRIS Proxy Edits CHGME Payment Program 2009 Workshop IRIS Proxy – Edits IRIS Proxy Edits The following input errors will result in the FTE being reduced to zero: Listed as a international/foreign medical school graduate but NO IMG/FMG Complete Date is entered A Graduation Date is NOT entered or date is NOT PRIOR to first rotational begin date Rotational Assignment Dates begin or end OUTSIDE of the fiscal year IRIS & IRIS Proxy 18

IRIS Proxy – Edit Check Edit Check CHGME Payment Program 2009 Workshop IRIS Proxy – Edit Check Edit Check Highly recommended that the IRIS data be validated by a separate IRIS/GME edit program CMS IRIS FI Edit Program (IRISEDV3) Same software used by Full Filing hospitals and all FIs Third-Party Vendor GME Software Data that does not pass CHGME FI edits may be returned to the hospital for rework. IRIS & IRIS Proxy 19

IRIS/IRIS Proxy Updates CHGME Payment Program 2009 Workshop IRIS/IRIS Proxy Updates New/Revised Program Codes Specialties Subspecialties Combined Programs IRIS & IRIS Proxy 20

Refer to Table of Medical Schools (page 7-10). CHGME Payment Program 2009 Workshop IRIS Proxy Updates Medical School Codes Revised 6 of 8 Podiatry Schools Codes 30100 – 30600 New Dental School Codes United States, Canada, Puerto Rico Codes 80002 – 80109 Replaced Codes Codes 30010 – 30090 for Podiatry Schools Codes 10000 and 20000 for all Dental Schools Refer to Table of Medical Schools (page 7-10). IRIS & IRIS Proxy 21

IRIS Proxy Updates Medical School Codes (continued) CHGME Payment Program 2009 Workshop IRIS Proxy Updates Medical School Codes (continued) 30010 – Barry University School of Podiatric Medicine (Miami Shores, FL) New Code - 30500 30020 – William M. Scholl College (Chicago, IL) New Code – 30100 30040 – College of Podiatric Medicine (Des Moines, IA) New Code - 30600 30050 – New York College of Podiatric Medicine (New York, NY) New Code - 30200 30080 – Ohio College of Podiatric Medicine (Cleveland, OH) New Code - 30300 30090 – Temple University School of Podiatric Medicine (Philadelphia, PA) New Code - 30400 IRIS & IRIS Proxy 22

IRIS Proxy Updates Current Version updated 2009 CHGME Payment Program 2009 Workshop IRIS Proxy Updates Current Version updated 2009 Addition of New Programs and Medical School Codes Updated Formatting Errors IRIS & IRIS Proxy 23

IRIS Common Errors CHGME Payment Program 2009 Workshop IRIS & IRIS Proxy 24

IRIS – Key Inputs Intern/Resident Name Employer Name CHGME Payment Program 2009 Workshop IRIS – Key Inputs Intern/Resident Name Do not use nicknames or abbreviations! Employer Name Institution currently paying the resident’s salary Residency Type Code Initial Specialty Program Specialty initially chosen by resident during the first year of post graduate training program Medical School Graduation Date If the specific graduation date cannot be determined, but the graduation month is known, use the first day of the known month IRIS & IRIS Proxy 25

Assignment Time Periods CHGME Payment Program 2009 Workshop Assignment Time Periods Assignment Beginning and Ending Date Resident’s start and end dates for EACH rotational assignment during which the intern/resident was assigned to and worked at the hospital complex or any of its hospital based providers. Follow original source documentation Rotation schedules, calendars, etc. IRIS & IRIS Proxy 26

GME Time Percentages GME Percentage CHGME Payment Program 2009 Workshop GME Time Percentages GME Percentage Percentage of time intern/resident worked in the hospital in comparison to the total time worked at all facilities (Resident’s Total GME must equal 100%) . If in a non-hospital setting must have a written agreement. Hospitals must coordinate GME data reported in IRIS IME % does NOT apply to Children’s hospitals. Enter the same % as the GME % or enter zero(0). IRIS & IRIS Proxy 27

Initial Specialty Initial Residency Period Prior to 10/01/04 CHGME Payment Program 2009 Workshop Initial Specialty Initial Residency Period Prior to 10/01/04 Determined as of the time the resident enters the “initial” or first residency training program Based on the period of board eligibility associated with the program in which a resident participates in the first year of training, without regard to specialty in which the resident ultimately seeks board certification IRIS & IRIS Proxy 28

Initial Specialty - Simultaneous Match CHGME Payment Program 2009 Workshop Initial Specialty - Simultaneous Match 69 FR 49170 (August 11, 2004) FY 2005 DRG Rates for Hospital Inpatient PPS CMS’ definition.. For purposes of direct GME, a national process by which applicants to approved medical residency programs are paired with programs on the basis of preferences expressed by both the applicants and the program directors IRIS & IRIS Proxy 29

Initial Specialty – First Policy Change CHGME Payment Program 2009 Workshop Initial Specialty – First Policy Change Effective for portions of cost reporting periods beginning on or after 10/01/04 If hospital documents…. Resident matched in an advanced specialty program that requires clinical base year prior to resident’s first training year Then…. IRP is determined based upon period of board eligibility associated with second year specialty program IRIS & IRIS Proxy 30

Initial Specialty – Second Policy Change CHGME Payment Program 2009 Workshop Initial Specialty – Second Policy Change 70 FR 47449 (August 12, 2005) Inpatient Hospital PPS for 2006 To claim specialty program as IRP.. Hospital must document that a resident matched PRIOR to beginning any residency training in an advanced residency training program beginning in the second residency year IRIS & IRIS Proxy 31

Initial Specialty – Supporting Documentation CHGME Payment Program 2009 Workshop Initial Specialty – Supporting Documentation National Residency Matching Program (NRMP) http://www.nrmp.org San Francisco Matching Program http://www.sfmatch.org Urology Matching Program http://www.auanet.org/residents/resmatch.cfm American Osteopathic Association Residency Match Program http://www.natmatch.com/aoairp IRIS & IRIS Proxy 32

Residency Years Completed CHGME Payment Program 2009 Workshop Residency Years Completed Residency Year The total number of years the intern/resident has completed in ALL types of approved residency programs Based on the number of years completed as of FIRST DAY of reported rotational assignment This includes CLINICAL BASE year or transitional year for “Matched Residents” Do NOT Use: Resident’s PGY Level or Only Years Complete in Current Specialty IRIS & IRIS Proxy 33

Document, Document, Document!!! CHGME Payment Program 2009 Workshop The key is …… Document, Document, Document!!! IRIS & IRIS Proxy 34

IRIS EDV3 Edit Program CHGME Payment Program 2009 Workshop IRIS & IRIS Proxy 35

IRISEDV3 What is the IRISEDV3? CHGME Payment Program 2009 Workshop IRISEDV3 What is the IRISEDV3? A program used to run edit checks on the Intern and Resident Information System (IRIS) diskette Available at no charge to hospitals Provides all major edit checks that will be done by your CHGME FI 36 IRIS & IRIS Proxy 36

IRISEDV3 - Setup Setup of the IRISEDV3 Obtain all necessary files: CHGME Payment Program 2009 Workshop IRISEDV3 - Setup Setup of the IRISEDV3 Obtain all necessary files: Edv3inst.exe Db5lib.exe Readme.doc Program should be on computer’s hard drive This is a MUST: Read the installation instructions (Readme.doc) BEFORE beginning installation! IRIS & IRIS Proxy 37

IRISEDV3 - Setup First Time Use CHGME Payment Program 2009 Workshop IRISEDV3 - Setup First Time Use The FIRST time the program is opened, complete “Data Management” from Main Menu IRIS & IRIS Proxy 38

IRISEDV3 - Setup First Time Use (cont.) Data Management CHGME Payment Program 2009 Workshop IRISEDV3 - Setup First Time Use (cont.) Data Management Setup Administrative Data Rebuild Data Indexes Be sure to save (“S”) set-up and exit (“X”) During Step <2> Rebuilding Data Indexes – Screen may flicker. This is okay! IRIS & IRIS Proxy 39

IRISEDV3 – Process Data <1> Capture IRIS Data Submitted CHGME Payment Program 2009 Workshop IRISEDV3 – Process Data <1> Capture IRIS Data Submitted Ensure diskette with IRIS files (M3XXXXXX.dbf and A3XXXXXX.dbf) is in the disk drive (usually “A”). Verify provider number is correct. <2> Import Captured Provider Data into Test Shells Automatically completed by program IRIS & IRIS Proxy 40

Assignment End Date is after FY End Date (12/31/2004) CHGME Payment Program 2009 Workshop IRISEDV3 – Process Data <3> Evaluate and Edit Imported Provider Data Provides on-screen EDITS during processing Assignment End Date is after FY End Date (12/31/2004) IRIS & IRIS Proxy 41

Default = <2> Print All Records CHGME Payment Program 2009 Workshop IRISEDV3 – Process Data <4> Print Report of Evaluation and Edit It is optional to print reports Default = <2> Print All Records IRIS & IRIS Proxy 42

IRISEDV3 – Reports Report Sections CHGME Payment Program 2009 Workshop IRISEDV3 – Reports Report Sections Part I – New Records that Passed all IRIS Edits Part II – Records that Failed One or More IRIS Edits e.g. Assignment date outside fiscal year Part III – Invalid Records e.g. Assignment record with invalid or blank fiscal year begin date Part III may also include any duplicate records in the Master File IRIS & IRIS Proxy 43

CHGME Payment Program 2009 Workshop IRISEDV3 – Reminders IRISEDV3 cannot be used to change data. It is only capable of edit checks. IRISEDV3 does not check for zero values or blanks in the Full Time/ Part Time Percentage (%) and GME Percentages (%) fields of the IRIS files. IRIS & IRIS Proxy 44

CHGME Payment Program 2009 Workshop IRISEDV3- Conclusion IRISEDV3 will greatly improve your chances of submitting a good IRIS/IRIS Proxy, but it will not guarantee complete success. The CHGME FI may determine that an IRIS/IRIS Proxy diskette is still incorrect even though it cleared IRISEDV3 edits. Example Full Time/Part Time Percentage (%) was entered as the portion of the year the intern/resident was at a hospital instead of the type of residency slot he/she filled. IRIS & IRIS Proxy 45