Wiki Use of Residents in Physician Practice?

[trarut]

Hello.
Can anyone assist with resources that discuss the use of Residents in a physician practice?

Thanks,
Tracy

 

[csperoni]

Hello.
Can anyone assist with resources that discuss the use of Residents in a physician practice?

Thanks,
Tracy

I think there are a lot of moving, compliance, and legal parts to this.
Is your practice part of a larger healthcare system?
What services will the residents be providing?
Would it meet Primary Care Exception guidelines?

From what I have seen, residents in a private physician practice would typically be shadowing the physician, and not independently providing services. In this scenario, no billable services are provided by the resident, so billing would be done under the physician. Residents might take history, confirm prescriptions, take chief complaint, and be present when physician is providing services.

However, in a health care system, there will often be what many call "clinics" where residents function more independently (but still under the supervision of a teaching physician). In that scenario, the healthcare system should have the appropriate legal and compliance experts to advise.

Basically, someone has to be running the residency program and they should be able to provide advice and resources.

 

[trarut]

Thanks for the response, Christine. I agree about the various pieces and all of them leave me uncomfortable.
We are an independent practice so there is no resource to go to. Initial discussion is that their time would be utilized for supervision of chemotherapy. It's been determined internally (by others) that it's acceptable because residents are able to prescribe but I've been tasked with determining supervision guidelines. I've never dealt with residents, related billing or anything teaching related and The Google has been less than helpful.

As I understand it, residents are physicians but are not fully licensed to work independently as such. To me, this means we would be billing using the supervising (teaching) physician. but I'm not sure we can bill as a teaching physicians (with a modifier) as a private practice. I don't think the concept of incident-to applies here since the resident is technically a physician. Any insight would be helpful.

Tracy

 

[yvonneflintdavis]

Private Practice BIlling perspective: We run rotations with the 1st yr, 2nd yr and 3rd yr residents. The residients are under direct supervision of our physicians regardless of place of service. They are scheduled 2 days in the clinic, 3rd yr residents go on call and round at the hsp, and follow patients discharged to snf. We use the GC modifer with the supervising physician. The resident is used as the scheduling provider so when we run reports the metrics are accuarate and we can see the residents are meeeting their goals. Hope this helps.

 

[trarut]

Thanks, Yvonne. That is helpful! Can you share what specialty this is for?

 

[yvonneflintdavis]

Thanks, Yvonne. That is helpful! Can you share what specialty this is for?

primary care

 

[TThivierge]

Hello.
Can anyone assist with resources that discuss the use of Residents in a physician practice?

Thanks,
Tracy

Trarut
May I add check out the modifiers GC and GR to add to CPT code plus statements on documentation from attending physician has reviewed work of resident and bill under attending doc as stated above.
Lady T

 

[jkyles]

Hi there, try this: https://www.cms.gov/files/document/guidelines-teaching-physicians-interns-residents.pdf It will also include links the regulations that were the source for the handbook.

 

[trarut]

Trarut
May I add check out the modifiers GC and GR to add to CPT code plus statements on documentation from attending physician has reviewed work of resident and bill under attending doc as stated above.
Lady T

I will check my notes to see if I reviewed those modifiers. Thanks!

 

[trarut]

Hi there, try this: https://www.cms.gov/files/document/guidelines-teaching-physicians-interns-residents.pdf It will also include links the regulations that were the source for the handbook.

Thank you! I did review that resource during my initial panicked round of research. While I found the references to the primary care exception, I was struggling with how to translated to a different specialty, if it even did. I was able to find enough information to formulate a response and I'm hoping the topic is no longer under consideration.

I appreciate the input I received from all of you!