Participation and Documentation Requirements for Teaching Physician Billing and Coding
Course Description: Services Furnished by an Intern or Resident Within the Scope of an Approved Training Program:
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.
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.
- Recognize situations in which the teaching physician billing rules apply.
- Summarize the specific documentation residents must record to demonstrate the required amount of teaching physician participation/performance was rendered.
- Implement specific participation/performance requirements that exist for each type of resident service.
- Identify when pertinent billing requirements have been met by the teaching physician.
Registration is only open to WKBH GME Faculty
Healthcare Coding and Reimbursement Consultant
Mr. Seth Canterbury has 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.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Nurse Practitioners
- 1.00 General certificate of attendance