Apurva Posted Mon 03rd of February, 2020 02:08:14 AM
Is there any specific guidelines to follow when billing for Physicians who are currently pursuing fellowship.
SuperCoder Answered Tue 04th of February, 2020 00:31:09 AM
Thank you for the Question!
As per CMS, An individual who participates in an approved GME Program or a physician who is not in an approved GME Program, but who is authorized to practice only in a hospital setting (for example, has a temporary or restricted license or is an unlicensed graduate of a foreign medical school).
For DGME and IME payment purposes, a resident means an intern, resident, or fellow who is formally accepted, enrolled, and participating in an approved medical residency program including programs in osteopathy, dentistry, and podiatry as required to become certified by the appropriate specialty board.
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 non-provider setting, the services furnished are payable in one of these ways:
1. Through payments to the hospital(s), if, among other things, one of these criteria are met: For DGME and IME purposes, if 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 non-provider setting
For DGME purposes, if he or she spends time in certain non-patient care activities in certain Non-provider settings and the hospital(s) incurs salary and fringe benefits of the resident or intern during the time he or she spent in the non-provider setting or
2. 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 non-provider setting, and the time spent in the non-provider setting is not counted by the hospital for DGME and IME payment purposes
Hope that Helps!