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History

CMS has always separated residents in Osteopathic programs from those in Allopathic programs by assigning different codes to the different types of “pathic.” Further, CMS has a standing policy that the program a resident starts training in should be preserved in the resident’s Master file (Not familiar with this “Master file” thing? See Technical Mumbo-Jumbo). For example, if a resident starts training in Family Medicine and decides after two years that they really want to be a surgeon, that resident’s CMS code in their Master file will always represent Family Medicine, even though the spend their final 3-4 years in surgery.

Enter SAS

As programs move from AOA to ACGME accreditation, their CMS codes will naturally change to reflect this difference. However, residents already in training in the program at the time of the accreditation change will need to preserve the Osteopathic code of their initial program in their Master file. Some general rules:

• Residents should be claimed using the code of the residency program they are training in regardless of the type of degree (MD or DO) that the resident has obtained
• Residents’ codes in their Master file should represent the type of program they were in when they started training
• Residents’ codes in their Assignment file should represent the type of program they were training in at of the dates of the assignment file record

What this means

Residents’ CMS codes in the Assignment file will need to reflect the accreditation of the program at the time of each rotation. Whether you transition at the start of an Academic Year or in the middle of one, there will need to be a before-and-after change represented in the CMS codes.

On the other hand, the Initial Program in the Master file needs to always reflect the first program that the resident was training in; even when that program’s code changes due to SAS, IRIS needs to “remember” that the resident started training in an Osteopathic program.

As things stand, the RMS doesn’t yet have the necessary before-and-after functionality. We are actively working on making this happen and will let you know as soon as it’s ready.

Technical mumbo-jumbo

If you’re not familiar with what the Master and Assignment files are, don’t worry: you’re not alone! In essence, the Master file is a snapshot of the resident on their first day of residency. While the contents of the master file may change under a few exceptional circumstances, the snapshot idea is a good way to think about the Master file. Being a snapshot, it rarely changes.

The Assignment file is like the rotation schedule, but with no clinical identification of the rotation (weird, I know). The Assignment file indicates the dates of the rotation and the resident’s training program but doesn’t get into detail about what the resident is actually learning. Keep in mind that IRIS is a financial auditing tool that is generally unconcerned with the educational aspect of the rotation.