Capital and direct medical education cost reimbursement

Facilities may request capital and direct medical education cost reimbursement. Capital items, such as property, structures and equipment, usually cost more than $500 and can depreciate under tax laws. Direct medical education is defined as formally organized or planned programs of study in which providers engage to enhance the quality of care at an institution.

Submit reimbursement requests for capital and direct medical education costs to WPS, Humana Military’s claims processor, on or before the last day of the 12th month following the close of the hospital’s cost-reporting period. The request should cover the one-year period corresponding with the hospital’s Medicare cost-reporting period. This applies to hospitals (except children’s hospitals) subject to the TRICARE DRG-based system.

When submitting initial requests for capital and direct medical education reimbursement, providers should include the following:

  • Hospital name
  • Hospital address
  • Hospital tax identification number
  • Hospital Medicare provider number
  • Time period covered (must correspond with the hospital’s Medicare cost-reporting period)
  • Total inpatient days provided to all beneficiaries in units subject to DRG-based payment
  • Total TRICARE inpatient days, provided in “allowed” units, subject to DRG-based payment (excluding non-medically necessary inpatient days)
  • Total inpatient days provided to ADSMs in units subject to DRG-based payment
  • Total allowable capital costs (must correspond with the applicable pages from the Medicare cost report)
  • Total allowable direct medical education costs (must correspond with the Medicare cost report)
  • Total full-time equivalents for residents and interns
  • Total inpatient beds as of the end of the cost-reporting period
  • Title of official signing the report
  • Reporting date

The submission must include a statement certifying that any changes, if applicable, were made as a result of a review, audit or appeal of the provider’s Medicare cost report. Report any changes to Humana Military and WPS within 30 days of the date the hospital is notified of the change. In addition, the provider’s officer or administrator must certify all cost reports.