In this episode, we are joined by Andy Sutton, Sr. Software Architect at BESLER, to discuss changes CMS is making to IRIS and how teaching hospitals submit reimbursement numbers for their residency programs.
Highlights of this episode include:
- Background on IRIS (intern and resident information system) and how it connected to Medicare cost reports.
- What changes are included in the redesign of the national IRIS system.
- When will the new software become available to teaching hospitals?
- What new functionality is included in the new software?
- And more…
BESLER has long been at the forefront of national reimbursement issues, securing millions of dollars in additional reimbursement for our clients. Visit our Reimbursement Services page to learn about our area of expertise.
Mike Passanante: Hi, this is Mike Passanante. And welcome back to the award-winning Hospital Finance Podcast®. This year CMS is going to be changing the way that teaching hospitals submit their numbers to CMS in order to get reimbursement for their residency programs. And to help us understand more about that issue, I’m joined by Andy Sutton, who is a senior software architect here at BESLER. Andy, welcome to the program.
Andy Sutton: Thanks for having me, Mike.
Mike: So, Andy, why don’t you tell us how you got involved in this particular issue and what’s actually happening?
Andy: Surely. Surely. I’ve been writing software for interns and residents for about 15 years now. And about 4 years ago, a committee was created by CGI Federal in conjunction with CMS, and it put together the main people in the intern and resident system. So we had the software vendors for cost reports – that would be KPMG and HFS – and a number of intern and resident software vendors, such as BESLER.
Mike: Great. And they’re making changes to something called the IRIS submission process. Why don’t you tell us what IRIS is and a little bit about why they’re making those changes?
Andy: Surely. Surely. IRIS stands for Intern and Resident Information Systems, and really what we’re doing is a full redesign of the national IRIS system. The current system in place was made back in the last century. That makes it sound nice and old, but it used really old, outdated software, DOS and dBASE, which by and large are no longer in use. So they’re creating a new system that uses an XML format, and while they’re doing that, they kind of added a few extra bells and whistles in to help with reporting of IRIS data.
Mike: Got it. So why don’t you walk us through some of the changes that are planned in that process?
Andy: So including the fact that the actual format is different of the files that need to be submitted with cost reports, they’ve added some new fields that will help CMS to report the different kinds of FTE loads that teaching hospitals have. So they’ve added in-patient psych, in-patient rehab, non-provider setting FTEs – that would be in the clinics or doctor’s offices – displaced residents, and new program FTEs. And all these are already in the cost report. The cost report is used so that the teaching programs can get reimbursement. So inside the cost report, there’s different fields, if you will, that you have to indicate different numbers of FTEs, and based on the reporting of those FTEs, the teaching programs get reimbursement. And that money comes from Medicare, and it’s the bulk of reimbursement for teaching hospitals and their programs.
Mike: And so this may sound redundant, but obviously, teaching hospitals are affected by this change. Are there any other types of providers that are affected by this change?
Andy: Mainly teaching hospitals. Any kind of system that has teaching hospitals, but by and large, teaching hospitals.
Mike: Those that have residency programs, right? Yeah.
Andy: Right. Right. Residency programs.
Mike: Yeah, no. That makes sense. Obviously, sometimes regarding these types of issues, they’re going to be targeted. As we intimated at the beginning of the program, we’re not 100% sure when the changes are going to actually come into effect. So this question might be difficult to answer, but when is it expected that providers will be in compliance?
Andy: We project that early this year they finally will be ready to go. And by and large, most teaching hospitals will be okay. Because the software vendors were involved, it was really a good joint effort that they put through. The CMS got us all together so that there won’t be any real big surprises. So the hospitals, providers, that use software for their interns and residents reporting? They’ll be ready based on the software changes that we know we have to make. There could be a few out there that the problem will be, did they use the outdated software that is being used to report their numbers? And so basically any facility, maybe with smaller teaching programs? They may have created their own files for submission with the cost report, but in this case, they won’t be able to do that anymore. Unless they have some kind of software architect onsite at the provider, they will need to use vendor software. So there is a section of the teaching hospital population that will need to know that they need to move to a software.
Mike: Andy, is there any other functionality that’s being brought into the new system that listeners should be aware of?
Andy: Yeah. There’s one other thing. There is kind of a big push to make sure there aren’t a lot of conflicts with the reporting of interns and residents. So some interns and residents will have their rotations at two separate facilities, both of which independently report to CMS their counts on their interns and residents. So in the past, it was a little bit of a struggle to make sure that different facilities weren’t over-counting their FTEs per resident. And with this new system, basically all of the information’s going to be going into one giant database, and they’ll be able to see and make sure the counts are all correct, and there isn’t any over-reporting.
Mike: Got it. And if you’re in a facility and you’re thinking about this particular change, is this just something they need to be thinking about for 2020 going forward? Or is CMS going to be retroactively looking at any of this data or expect the hospitals to do anything with that from prior year?
Andy: Yeah. We were told that this will only be going forward. They won’t be going back and re-opening things based on the new rules or anything like that. So as long as they’re set, they have some software that’s been updated for the new rules, they should be okay.
Mike: Great. For anyone in our audience that is dealing with this particular issue, if you do have any questions about it that we can be helpful with, please drop us a line at email@example.com. And as Andy mentioned, if you’re in a position where you need to have some software to help deal with this particular issue, we do offer a software package called iRotations and you can head up to besler.com. Just go to the Reimbursement Services tab, and you can read more about that.
Mike: Andy, thanks so much for joining us today on the Hospital Finance Podcast.
Andy: Thanks for having me, Mike.