PRRB Dec. No. 2019-D38

Whether the Provider, as a Sole Community Hospital (SCH), was properly reimbursed for indirect medical education costs for services provided to Medicare Advantage (MA or Part C) patients for the cost reporting period in dispute. In particular, whether the Cost Report Worksheet E Part A properly calculates the indirect medical education (IME or indirect GME) settlement on Medicare Manage Care claims, for SCH whose hospital-specific rate (HSR) exceeds the hospital’s inpatient prospective payment (IPPS) Federal rate.