IRIS & IRIS Proxy

Children’s Hospitals

Graduate Medical Education

Payment Program

AgendaI. IRIS II. IRIS Proxy UpdatesIII. IRIS Common ErrorsIV. IRIS EDV3 Edit ProgramV. Q & A Session

I. IRISIntern and Resident Information

System

IRIS Recap

Who can use the IRIS?Full Filing Providers

DOS based program (CMS) Does NOT compute the FTE count of

interns/residents

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.

IRIS V3 Updates Residency Code Table in Alphabetic Sequence Operating Instructions

NewPart II, Section 7.4Part V

RevisedPart II, Section 7.2Part II, Section 7.3Part II, Section 7.5

Refer to Table of Residency Codes (page 7-17).

IRIS V3 ClarificationsEmployer’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 V3 Clarifications Residency Years Completed

Range for Total Number of Program Years

Medical School Code“99998” – Foreign Dental School“99999” – Foreign Medical SchoolDental School Codes

10000 & 20000 – ObsoleteUse New Codes 80002-80109

IRIS V3 Clarifications• Assignment Time Periods

Added Non-Hospital Reference42 CFR 413.78(e)

Periods that Span July 1Enter as 2 periods on IRISExample

Fiscal Year : 10/01/04 – 09/30/05Rotation: 05/01/05 – 11/30/05Report Assignments:

• 05/01/05 - 06/30/05• 07/01/05 - 09/30/05

IRIS V3 Updates – Effective Dates

New Dental School CodesFor cost reporting periods BEGINNING on

or after July 1, 2006 ANDInterns & Residents (I&Rs) in dental

specialties with dental school Graduation Dates after April 30, 2006

New Residency Type CodesHighlighted in YELLOW

IRIS V3 Reminders Assignment File

Percentages (GME/IME %, Part/Full time PercentUse Whole Numbers

Social Security NumbersLinks the Assignment file to the Master file

CMS Assistance http://www.cms.hhs.gov/IRISIris@cms.hhs.gov

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.

II.IRIS PROXY

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

IRIS Proxy Calculates Total GME Unweighted and

Weighted Resident FTE counts by:Each Intern/Resident RotationCurrent SpecialtySummary Totals

Total Allopathic and Osteopathic ResidentsTotal Allopathic and Osteopathic in Initial Residency

PeriodTotal Dental and Podiatric ResidentsTotal Dental and Podiatric Residents in Initial Residency

Period Option to create IRIS Master and

Assignment data files

IRIS Proxy – Summary Totals

Summary Totals Located in upper right corner of the

worksheet         

Total FTEsUnweighted

Total FTEsWeightedSUMMARY TOTALS:    

Total Allopathic & Osteopathic Residents 0.2179 0.1718

Total Dental & Podiatric Residents 0.4180 0.4180

Summary Totals do NOT account for any duplicate assignment periods (overlaps).

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

Update Totals Report

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

IRIS Proxy – Edit Check Edit Check

Highly recommended that the IRIS data be validated by a separate IRIS/GME edit programCMS IRIS FI Edit Program (IRISEDV3)

Same software used by Full Filing hospitals and all FIs

Third-Party Vendor GME SoftwareData that does not pass CHGME FI edits may

be returned to the hospital for rework.

IRIS/IRIS Proxy Updates New/Revised Program Codes

SpecialtiesSubspecialtiesCombined Programs

IRIS Proxy Updates Medical School Codes

Revised 6 of 8 Podiatry SchoolsCodes 30100 – 30600

New Dental School CodesUnited States, Canada, Puerto RicoCodes 80002 – 80109

Replaced CodesCodes 30010 – 30090 for Podiatry SchoolsCodes 10000 and 20000 for all Dental

SchoolsRefer to Table of Medical Schools (page 7-

10).

IRIS Proxy UpdatesMedical School Codes (continued)

30010 – Barry University School of Podiatric Medicine (Miami Shores, FL)

New Code - 30500 30020 – William M. Scholl College (Chicago, IL)

New Code – 30100 30040 – College of Podiatric Medicine (Des Moines, IA)

New Code - 30600 30050 – New York College of Podiatric Medicine (New

York, NY)New Code - 30200

30080 – Ohio College of Podiatric Medicine (Cleveland, OH)

New Code - 30300 30090 – Temple University School of Podiatric Medicine

(Philadelphia, PA)New Code - 30400

IRIS Proxy Updates Current Version updated 2009 Addition of New Programs and

Medical School Codes Updated Formatting Errors

III.IRIS Common Errors

IRIS – Key Inputs Intern/Resident Name

Do not use nicknames or abbreviations! Employer Name

Institution currently paying the resident’s salary

Residency Type CodeInitial Specialty Program

• Specialty initially chosen by resident during the first year of post graduate training program

Medical School Graduation DateIf the specific graduation date cannot be

determined, but the graduation month is known, use the first day of the known month

Assignment Time Periods Assignment Beginning and Ending

DateResident’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 documentationRotation schedules, calendars, etc.

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).

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

Initial Specialty - Simultaneous Match

69 FR 49170 (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

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

Initial Specialty – Second Policy Change

70 FR 47449 (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

Initial Specialty – Supporting Documentation

National Residency Matching Program (NRMP)http://www.nrmp.org

San Francisco Matching Programhttp://www.sfmatch.org

Urology Matching Program http://www.auanet.org/residents/resmatch.cfm

American Osteopathic Association Residency Match Programhttp://www.natmatch.com/aoairp

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

The key is ……

Document, Document, Document!!!

I. IRIS EDV3 Edit Program

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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

IRISEDV3 - SetupSetup of the IRISEDV3

Obtain all necessary files: Edv3inst.exeDb5lib.exeReadme.doc

Program should be on computer’s hard drive This is a MUST:

Read the installation instructions (Readme.doc) BEFORE beginning

installation!

IRISEDV3 - Setup First Time Use

The FIRST time the program is opened, complete “Data Management” from Main Menu

IRISEDV3 - Setup First Time Use (cont.)

Data ManagementSetup Administrative DataRebuild Data Indexes

Be sure to save (“S”) set-up and exit (“X”)

During Step <2> Rebuilding Data Indexes – Screen may flicker. This is okay!

IRISEDV3 – Process Data

<1> Capture IRIS Data SubmittedEnsure 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 ShellsAutomatically completed by program

IRISEDV3 – Process Data

<3> Evaluate and Edit Imported Provider DataProvides on-screen EDITS during

processing

Assignment End Date is after FY End Date

(12/31/2004)

IRISEDV3 – Process Data <4> Print Report of Evaluation and

Edit It is optional to print reports

Default = <2> Print All Records

IRISEDV3 – Reports Report Sections

Part I – New Records that Passed all IRIS Edits

Part II – Records that Failed One or More IRIS Editse.g. Assignment date outside fiscal year

Part III – Invalid Recordse.g. Assignment record with invalid or

blank fiscal year begin datePart III may also include any duplicate

records in the Master File

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.

IRISEDV3- 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.