关键词：电子信息；信息系统；医疗报告；审查
摘 要：Since its inception in 1965, the Medicare program has shared in the costs of educational activities incurred by participating hospitals. The Centers for Medicare & Medicaid Services (CMS), which administers the Medicare program, makes two types of payments to teaching hospitals to support graduate medical education (GME) programs for physicians and other practitioners. Direct GME payments are Medicare's share of the direct costs of training interns and residents, such as salaries and fringe benefits of residents and faculty and hospital overhead expenses. (In this report, 'resident' includes hospital interns.) Indirect GME payments cover the additional operating costs that teaching hospitals incur in treating inpatients, such as the costs associated with using more intensive treatments, treating sicker patients, using a costlier staff mix, and ordering more tests. Highmark Medicare Services, Inc. (Highmark) is a Medicare Administrative Contractor (MAC) under contract with CMS to administer the Medicare Part A (hospital insurance) program. Highmark administers the program for MAC Jurisdiction 12, which consists of four States-Pennsylvania, Maryland, New Jersey, and Delaware-and the District of Columbia. For fiscal year (FY) ended in 2006, 133 hospitals in MAC Jurisdiction 12 collected and reported information to the IRIS on residents. In FY ended 2007, the figure was 132 hospitals. The objective of our review was to determine whether hospitals in MAC Jurisdiction 12 claimed Medicare GME reimbursement for residents in accordance with Federal requirements.