Graduate Medical Education (GME) payment
GME payments are Medicare add-ons to hospital payment that help fund the cost of training resident physicians, paid per resident and tied to teaching hospitals.
Updated
Graduate Medical Education (GME) payments are Medicare payments to teaching hospitals that help fund the cost of training resident physicians. They are made up of Direct Graduate Medical Education (DGME) payments, which support the direct costs of residency programs (stipends, supervising physicians, and administration), and Indirect Medical Education (IME) payments, which are add-ons to the inpatient prospective payment that compensate teaching hospitals for the higher patient-care costs associated with training residents.
GME payments are calculated from the hospital's resident counts, full-time-equivalent resident caps, and cost-report data, not from an individual claim. They are reconciled through the Medicare cost report and apply to qualifying teaching hospitals, with statutory caps on the number of reimbursable residents that have been the subject of periodic legislative change.
In practice
For billing, GME is a cost-report–driven settlement, not a per-claim adjustment; the individual claim's payment is not where GME shows up. A teaching hospital's finance and compliance teams, rather than the per-claim biller, manage the resident counts and caps that determine the GME amounts, and inaccurate resident reporting is a recognized compliance risk.
Commonly confused with
- Disproportionate Share Hospital (DSH) payment: Both DSH and GME are Medicare hospital add-on payments driven by cost-report data; DSH adjusts for low-income patient share, GME adjusts for the teaching burden. They are separate adjustments that can both apply to the same hospital.