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

2. 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

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

4. 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

5. 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.
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6. 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).
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7. 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

8. 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 & – Obsolete
Use New Codes
IRIS & IRIS Proxy 8

9. IRIS V3 Clarifications Assignment Time Periods
CHGME Payment Program 2009 Workshop
IRIS V3 Clarifications
Assignment Time Periods
Added Non-Hospital Reference
42 CFR (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/ /30/05
07/01/ /30/05
IRIS & IRIS Proxy 9

10. 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
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11. 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

12. 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.
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13. CHGME Payment Program 2009 Workshop
IRIS PROXY
IRIS & IRIS Proxy 13

14. 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
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15. 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

16. 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).
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17. 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
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18. 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
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19. 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

20. 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

21. 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 – 30600
New Dental School Codes
United States, Canada, Puerto Rico
Codes – 80109
Replaced Codes
Codes – for Podiatry Schools
Codes and for all Dental Schools
Refer to Table of Medical Schools (page 7-10).
IRIS & IRIS Proxy 21

22. 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
30020 – William M. Scholl College (Chicago, IL)
New Code – 30100
30040 – College of Podiatric Medicine (Des Moines, IA)
New Code
30050 – New York College of Podiatric Medicine (New York, NY)
New Code
30080 – Ohio College of Podiatric Medicine (Cleveland, OH)
New Code
30090 – Temple University School of Podiatric Medicine (Philadelphia, PA)
New Code
IRIS & IRIS Proxy 22

23. 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

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

25. 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

26. 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

27. 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

28. 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

29. Initial Specialty - Simultaneous Match
CHGME Payment Program 2009 Workshop
Initial Specialty - Simultaneous Match
69 FR (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

30. 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

31. Initial Specialty – Second Policy Change
CHGME Payment Program 2009 Workshop
Initial Specialty – Second Policy Change
70 FR (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

32. Initial Specialty – Supporting Documentation
CHGME Payment Program 2009 Workshop
Initial Specialty – Supporting Documentation
National Residency Matching Program (NRMP)
San Francisco Matching Program
Urology Matching Program
American Osteopathic Association Residency Match Program
IRIS & IRIS Proxy 32

33. 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
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34. Document, Document, Document!!!
CHGME Payment Program 2009 Workshop
The key is ……
Document, Document, Document!!!
IRIS & IRIS Proxy 34

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

36. 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

37. 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

38. 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
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39. 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

40. 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
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41. 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

42. 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

43. 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
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44. 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.
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45. CHGME Payment Program 2009 Workshop
IRISEDV 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.
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