An attending physician’s services (other than an interns and residents) rendered to patients in a teaching setting are covered under Part B when properly documented. Many physicians rendering such services are on the faculty of a medical school or have arrangements with providers to supervise and teach interns and residents. Payment for professional services to a patient by an 'attending' physician may be made where the attending physician provides personal identifiable direction to interns or residents who are participating in the care of this patient.
For purposes of services furnished in a teaching setting under Medicare, the following definitions apply.
An individual who participates in an approved graduate medical education (GME) program or a physician who is not in an approved GME program but who is authorized to practice only in a hospital setting.
- The term includes interns and fellows in GME programs recognized as approved for purposes of direct GME payments made by the Part A Medicare Administrative Contractor (MAC)
- Receiving a staff or faculty appointment or participating in a fellowship does not by itself alter the status of "resident"
- Additionally, this status remains unaffected regardless of whether a hospital includes the physician in its full time equivalency count of residents
An individual who participates in an accredited educational program (e.g., a medical school) that is not an approved GME program.
- A student is never considered to be an intern or a resident
- Medicare does not pay for any service furnished by a student
A physician (other than another resident) who involves residents in the care of his or her patients.
Direct Medical and Surgical Services
Services to individual beneficiaries that are either personally furnished by a physician or furnished by a resident under the supervision of a physician in a teaching hospital making the reasonable cost election for physician services furnished in teaching hospitals.
- All payments or such services are made by the Part A MAC for the hospital
A hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry or podiatry.
Any provider, hospital-based provider or nonprovider setting in which Medicare payment for the services of residents is made by the Part A MAC under the direct graduate medical education payment methodology or freestanding Skilled Nursing Facility (SNF) or Home Health Agency (HHA) in which such payments are made on a reasonable cost basis.
Critical or Key Portion
That part or parts of a service that the teaching physician determines is (are) a critical or key portion(s). For purposes of Medicare teaching physician guidelines, these terms are interchangeable.
The teaching physician is located in the same room (or partitioned or curtained area, if the room is subdivided to accommodate multiple patients) as the patient and/or performs a face-to-face service.
Notes recorded in the patient's medical records by a resident, and/or teaching physician or others as outlined in the specific situations below regarding the service furnished. Documentation may be dictated and typed or hand-written, or computer-generated and typed or handwritten. Documentation must be dated and include a legible signature or identity. Pursuant to 42 CFR 415.172 (b), documentation must identify, at a minimum, the service furnished, the participation of the teaching physician in providing the service, and whether the teaching physician was physically present.
In the context of an electronic medical record, the term "macro" means a command in a computer or dictation application that automatically generates predetermined text that is not edited by the user.
When using an electronic medical record, it is acceptable for the teaching physician to use a macro as the required personal documentation if the teaching physician adds it personally in a secured (password protected) system. In addition to the teaching physician’s macro, either the resident or the teaching physician must provide customized information that is sufficient to support a medical necessity determination. The note in the electronic medical record must sufficiently describe the specific services furnished to the specific patient on the specific date. It is insufficient documentation if both the resident and the teaching physician use macros only.
- Refer to the Palmetto GBA FAQs for more information about services provided by teaching physicians
- CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, section 30 (PDF, 1.33 MB)
- CMS Medicare Claims Processing Manual (Pub. 100-04), Chapter 12, section 100 and 100.1.1.C (PDF, 1.1 MB)