The purpose of the IRIS program is to capture information about interns and residents in approved programs who work at hospitals that participate in the Medicare program as required by 42 CFR 413.75 (Direct Graduate Medical Education) and 42 CFR 412.105 (Indirect Medical Education). This information is used to determine Medicare payments for both IME and GME. The data submitted is subjected to a certain edit criteria and any disk that does not pass 100% of the edits will be returned to the provider. The data will need to be re-submitted until it does pass all of the edits. Once all edits are passed, the data will be loaded into the IRIS Database. From this database, we will generate reports detailing claimed FTEs by cost reporting year and identifying overlaps with other facilities. These reports are used by our audit staff as a basis for determining allowable FTEs in their review of your GME reimbursement.
The resolution of overlaps or duplicate rotations is the responsibility of each individual hospital. The fiscal intermediary will not decide who may claim a resident. The FTEs will be excluded from reimbursement for BOTH facilities if the providers cannot reach an agreement.
Most fields in the IRIS program are self-explanatory but some need additional explanation.
TOTAL YEARS - THIS IS NOT THE "PGY" YEAR. This is referred to in IRIS as "YRS", "RES YRS", or "YRS CMP", and on our database reports, as "Yrs. Compl". The amount in this field should identify the number of full years this resident has completed in all approved residency programs in which (s)he has ever been enrolled. Thus during the first year of residency, the total years completed will equal zero ("0"). In the second year, one ("1") year will have been completed. And so on. All rotations that overlap the beginning of a new school year (July 1st), should be split as of June 30th so that you can properly record the incrementation of Total Years Completed. This will be the case with a majority of the residents. However, you may have situations where the resident took some time away from the program and returned mid-year. In that case, you would split the rotation at their new anniversary date.
FULL-TIME/PART-TIME PERCENTAGE
In IRIS this may be known as "FTPT", "FTE%", and, in our reports, as " F/P%." Unless this resident is filling a part-time residency slot OR is sharing a full-time residency slot with another resident, this amount should be always be 100%. Shared slots and part-time residencies are rare. If you are claiming less that 100% in this field you may not be getting your full compliment of FTEs.
GME PERCENTAGE AND IME PERCENTAGE
This is the amount of time, during this ASSIGNMENT period, that the resident spent at your facility. It is often best to submit shorter rotation or assignment periods at 100% rather than longer assignment periods (e.g., one month, six-months, or a year) at a lesser percentage. This will allow you to avoid some overlap problems with other facilities. DO NOT weigh this percentage by the number of days in the rotation period.