Corporate Compliance

Billing issues related to teaching physicians

Compliance Monitor, December 16, 2005

Q: Residents at my facility trust that the registration insurance information recorded by the registration staff is accurate when a secondary payer is not identified. Therefore, a teaching physician may or may not see patients who have a secondary government payer in addition to the primary commercial payer. If the teaching physician does see the patient, only the resident documents the encounter and there is no teaching attestation note. Is this a potential compliance violation?

A: If the teaching physician plans to bill for services provided to a patient, he or she either has to provide the care, or ensure that the rules for billing for services are followed if he or she plans to rely on the care provided by a resident (see related Q&A below). It is not the resident's responsibility to know the billing status of the patient; it is the teaching physician's responsibility. Don't assume that the registration process provides reliable information. Teaching physicians should follow the Medicare billing rules for all patients for whom they intend to render a bill in order to avoid making mistakes. Indeed, I have seen a number of contracts executed with managed care payors that impose the same resident supervision requirements for those private pay patients. Therefore, there is no guarantee that the requirement only applies to Medicare patients. Moreover, as a reminder, teaching physicians cannot bill for services provided by medical students under any circumstances, even if they follow the rules for residents. They have to provide all the care for those medical students' patients for whom they render a bill.

Thanks to John Reiss, Esq., partner at Saul Ewing, LLP, in Philadelphia.

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