(1) "Resident" is an individual who participates in an approved graduate medical education (GME) program. The term includes both interns and fellows, but it excludes medical students enrolled at the undergraduate level.
(2) "Teaching practitioner" is a practitioner, other than a resident, who involves residents for pedagogical reasons in the care of the practitioner's patients.
(B) Coverage. Payment may be made to a teaching practitioner for services performed individually by a resident under supervision or jointly by the teaching practitioner and a resident. The following provisions apply:
(1) The teaching practitioner must provide the level of supervision appropriate to the procedure or service.
(2) The teaching practitioner need not be physically present when a resident performs a service if both of the following conditions are met:
(a) The resident provides one of the following low- or mid-level evaluation and management (E&M) services:
(i) Office or other outpatient visit, new patient;
(ii) Office or other outpatient visit, established patient;
(iii) Preventive medicine visit, new patient;
(iv) Preventive medicine visit, established patient; or
(v) E&M service reported as a prenatal visit; and
(b) The service is provided in a primary care center for which the following criteria are satisfied:
(i) The primary care center is located in a hospital outpatient department or other ambulatory care entity that receives GME payment for the time spent by residents in patient care duties; and
(ii) An authorized administrator attests in writing and maintains supporting documentation that the primary care center administers a residency program conforming to the medicare teaching practitioner policy set forth in 42 C.F.R. 415.174 (October 1, 2014) in at least one of the following specialties:
(a) Family practice;
(b) General internal medicine;
(d) Obstetrics and gynecology; or
(e) Geriatric medicine.
(C) Limitation. No payment is made to a teaching practitioner for services rendered by a resident practicing outside a primary care center without the presence of the teaching practitioner.
(D) Accountability. The teaching practitioner assumes responsibility for the accuracy of the patient's medical file.
Five Year Review (FYR) Dates: 04/01/2021
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
Prior Effective Dates: 04/07/1977, 12/21/1977, 12/30/1977, 07/01/1980, 10/01/1987, 09/01/1989, 01/01/2001, 09/01/2005, 02/12/2006