Medicare’s Teaching Physician Billing Guidelines
Medical and surgical services furnished by an intern or resident within the scope of his or her training program are covered as provider services and Medicare pays for them through Direct Graduate Medical Education (DGME) and Indirect Medical Education (IME) payments. These services may not be billed or paid under the Medicare PFS. When interns or residents are in an approved program and training in a nonprovider setting, the services furnished are payable in one of the following ways:
a. Through DGME and IME payments to the hospital(s), if, among other things, he or she: Provides patient care activities and the hospital(s) incurs salary and fringe benefits of the resident or intern during the time spent in the nonprovider setting; or
b. For DGME purposes, spends time in certain nonpatient care activities in certain nonprovider settings and the hospital(s) incurs salary and fringe benefits of the resident or intern during the time he or she spent in the nonprovider setting; or
c. Through the Medicare PFS if, in part, the regulations concerning the hospital’s receipt of DGME and IME payments are not met for the time spent in a nonprovider setting, and the time spent in the nonprovider setting is not counted by the hospital for DGME and IME payment purpose.
Please join Mr. Seth Canterbury for the Medicare’s Teaching Physician Billing Guidelines webinar.
West Kendall Baptist Hospital GME faculty including: Family medicine practitioners, cardiologists, emergency medicine physicians, surgeons, hospitalists, Ob/Gyn’s, nephrologists, hematologists/oncologists, infectious disease specialists, gastroenterologists, neurologists, ENT’s, ophthalmologists, urologists, pulmonologists, critical care physicians, nurses, medical students, residents, fellows and other interested healthcare professionals.
- Apply Medicare’s participation requirements for a teaching physician to bill a service performed in large part by a resident.
- Implement appropriate documentation required to demonstrate the above.
Healthcare Coding and Reimbursement Consultant
Mr. Seth Canterbury indicated that neither he nor his spouse/partner have relevant financial relationships with commercial interest companies, and he will not include off-label or unapproved product usage in his presentation(s) or discussion(s).
Non-faculty contributors and others involved in the planning, development, and editing/review of the content have no relevant financial relationships to disclose.
Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Baptist Health has been re-surveyed by the ACCME and awarded Commendation for 6 years as a provider of CME for physicians.
Baptist Health South Florida designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity has been approved for 1 credit hour, CE Broker Course #20-704723, by the Florida Boards of Medicine and Osteopathic Medicine and by the Florida Council of Physician Assistants.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 General certificate of attendance
- 1.00 Nurse Practitioners
Technical Support: If you are experiencing technical difficulties or have received an error message, please send an email to CME@BaptistHealth.net and include a print screen of the error message, your browser name and version, username and URL where the error occurred. You can expect a response within 48 hours.